Saturday, April 30, 2005

They can always move

If you are a military person and you want to "get" some bad people literally holed up several hundred meters underground, what do you want? A nuclear "bunker busting" bomb. Naturally. What would you call it? Well the Bush Administration calls it a Robust Nuclear Earth Penetrator (since you know the Bush administration I feel confident I don't have to add the qualifying phrase, "No, really. I'm not kidding.").

But wait. The US arsenal already has one of those, you say, the B61-11 bomb. No good. Doesn't penetrate solid rock. For that we need nuclear (or if you speak dialect, nucular). This way you can get at the estimated 100 "potential-enemy" complexes built 100 to 400 meters underground or the 2000 strategic hardened or buried targets in urban areas. We know they are there because military intelligence sources tell us so. That's probably also where the Iraqi WMD are, too. If not, we'd like to put some of our own WMDs there.

The trouble is that to get good penetration you must detonate them a bit underground to get the required energy transfer downwards. And that turns out to be difficult, according to a National Research Council report issued April 27. This from an excellent article in New Scientist by Jeff Hecht:
Most of that advantage comes from penetrating just 3 metres into the ground. Once this depth is obtained, a 300-kiloton earth penetrator could destroy a target buried 200 m deep, while a 1-megaton weapon would be needed for a target 300 m underground.

The problem is that earth penetrators cannot plunge deeply enough into the ground to fully contain the effects of a nuclear blast, so casualties would be "for all practical purposes, equal to [those] from a surface burst of the same weapon yield”, the report suggests. That means surface casualties could be high.


"Using an earth-penetrating weapon to destroy a target 250 meters deep - the typical depth for most underground facilities - potentially could kill a devastatingly large number of people," said John Ahearne, chair of the report committee.
Not to worry. Why are those people living near enemy facilities anyway? They probably work there. So if they don't want to be "taken out" along with the bunker, they should quit their jobs and move.

Update, 5/2/05: The Bulletin of the Atomic Scientists has more information in a piece by Jonas Siegel here (.pdf).

Friday, April 29, 2005

Now till Doomsday

The race to build "high containment" laboratories in universities to take advantage of burgeoning research funding for "select agent" organisms (potential biowarfare agents) is heating up, but the scrutiny over their operation is ice cold. Edward Hammond, Director of the Sunshine Project, has been trying to get the minutes supposedly kept by all Institutional Biosafety Committees and has met with either stonewalling or few results. Many IBCs, it seems, conduct their required meetings to "review" safety protocols entirely by email or telephone (and I have more than some suspicion that without a paper trail, some don't "review" at all).

IBCs go back to the mid 1970s when scientist-activists raised concerns about possible health and environmental consequences of recombinant DNA research. Guidelines, contained in a 130 page NIH document set out safe practices and protocols. IBCs must be registered with NIH and file annual reports. An excellent article by Kelly Field in this week's Chronicle of Higher Education (subscription required, alas) notes that when IBCs in institutions with research grants from NIH don't hold face to face meetings and keep minutes of their deliberations and decisions, they are in violation of these federal guidelines. Both NIH and the institutions acknowledge there is widespread violation of the requirement, but with one rather unusual (and probably unique) exception, no institution has been penalized or censured.

Now the IBCs, who have done such an outstandingly bad job with the task at hand, are being asked to take on another: reviewing "dual use" research, that is, work that might be used to harm or for warfare:
. . . [I]n 2003 a National Academy of Sciences panel recommended making the IBC system "the first review tier for experiments of concern." Such experiments would include studies designed to create vaccine-resistant microbes, enhance the virulence of a pathogen, or "weaponize" a biological agent or toxin. It also proposed a new national advisory board to provide general guidance and case-specific advice to the biosafety committees (Kelly Field in The Chronicle)
Whoa, there. Wait a minute! What's the "other" use in these kinds of "dual use" experiments? Maybe there are some legitimate uses, here, but they would be very rare and everyone should know when this kind of work is being done. And how would you tell them from offensive weapons work? The very fact routine IBCs would be charged with reviewing this kind of research suggests it might be considerably more common than would be expected in a country that is a signatory to the Biological Weapons Convention (although we won't permit inspections). This is just the kind of activity that is encouraged the Bush/Republican/Joe Lieberman skunk world of biodefense initiatives.

This work is being spun as public health-oriented research on "emerging infectious diseases." And that the phantom IBCs are adequate oversight.

They'll probably keep telling us this from Now till Doomsday.

Thursday, April 28, 2005


The obesity wars continue. They are interesting. I read the recent JAMA article (April 20 issue) and as far as I can see it is well done (although I am not an expert in this particular area, I am a chronic disease epidemiologist). What the data seem to show is that the previous CDC definition of optimal weight, as measured by Body Mass Index and using risk of death as an outcome (rather than morbidity) should be redefined, moving slightly upward. The data still reveal considerable increased mortality (112,000 excess deaths) for the truly overweight (BMIs above 30).

So why is this interesting? Because of the smarmy politics. The Right wing didn't complain much about highlighting obesity when it was conceived of as a personal failing, a lack of will-power and discipline. Obese people eat too much. But then the public health started to call attention to the structural determinants of excess caloric intake (advertising, mass marketing of unhealthy foods, easy access and marketing to school children, etc.). When the tort system became involved (obesity lawsuits against fast food chains) the Right saw an opportunity and turned against the obesity meme. Public health never had its act together because the notion that there is some personal accountability involved in excess weight is a widely shared cultural notion (I am taking no position as to its truth or falsity here). In addition there were other interests involved. The anti-smoking portion of public health was dismayed to have cigarettes displaced as the number one killer and fiercely attacked the first (and faulty) CDC study. I think it is fair to say, too, that there was more than a little hype about the dangers of obesity. This made the "obesity epidemic" a prime (and easy) target for the Right.

Enter astroturf "non-profits" to take advantage of the confusion caused by the latest correction. Full-page ads appeared in major newspapers dismissing concerns about obesity and casting doubt on public health science. Today's WaPo has the story of one of these phony "consumer" groups, the Center for Consumer Freedom, which describes itself as a "nonprofit organization dedicated to protecting consumer choices and promoting common sense." Yeah, Right. Right as rain. Right. Very, very Right.

It turns out the Center for Consumer Freedom, which has been running full page adds warning readers of the "obesity myth," was born ten years ago (maiden name, Guest Choice Network) as the bastard offspring of Big Tobacco and the restaurant industry to fight anti-smoking bills in restaurants. As they started to lose that fight they shifted to mad cow disease and genetically modified foods. Now anti-anti-obesity is their cash cow (don't get mad, get cash). It has dumped $1.1 million into the lap of a real scumbag, 62 year old Richard Berman, a lobbyist who also runs the American Beverage Institute (fighting restrictions on alcohol use) and the Employment Policies Institute Foundation (fighting minimum wage).

Berman would love it for the bright lights to stop shining on the kitchens of his clients. That way we don't see what is going on. And of course, when you turn out the lights, the vermin start to scurry around to do their business. Like Richard Berman.

Wednesday, April 27, 2005

Quiet heroes of public health

Earlier this month folks at Boston University School of Public Health hosted a "Summit" for progressive public health students. The Reveres were there and so were students from five states. And so was Peter Montague.

For those not familiar with Peter, he is one of the true heroes of the environmental movement, although pretty low profile. Peter's Environmental Research Foundation ("News and resources for environmental justice.") has as it mission, "Providing understandable scientific information about human health and the environment." And it has been doing just that through Rachel's Environment and Health News since the mid 1980s. Peter has produced well over 800 of these two-page, information dense newsletters, a prodigious feat. And #841 is devoted to a question that came up at the Summit regarding the relative absence of public health professionals on the activist front.

This is a question that has preoccupied the Reveres as well. It would seem students of public health would be among the most fertile groups for activist organizing. They are concerned with social justice, understand the effects of social policy on health and well-being, are more than usually dedicated to service and are intelligent and well educated (two attributes that don't always go together). But Schools of Public Health have always been lousy recruiting grounds for activists, and practicing public health professionals have been more than usually fearful about speaking out on public health matters. Peter's latest newsletter gives some examples of the latter (which many of us could multiply many-fold) and he suggests some reasons why those in control of society might wish to keep public health cowed. But he doesn't explain exactly why public health students and professionals are so hesitant and timid. It is a question worth pondering.

First, the practicing professionals. Probably the majority work in the public sector. Speaking out, more often than not, involves criticizing their employer (at least at some level). And public health professionals identify to some extent with their agencies and its mission, making attacking them even more difficult. Attacking the agency also amounts to whistle-blowing and whistle-blowers are uncommon in any field of endeavor.

Yet as Peter notes, public employees are usually better protected than most. While fear is prevalent, in fact it is rarely justified, at least with respect to their jobs. But their Achilles Heel may lie in one of their strengths: dedication to their mission and the agency and programs they have built or that they implement. Even the "professional" parts of the public sector are often very political and use political means of taking reprisals. One of those highlighted in Peter's newsletter recognized that one of the things they could to to her, rather than fire her, would be to "make her life miserable." For public health types, that means cutting your program's budget and gutting it by laying off your staff, then reassigning you to mind-numbing make-work under adverse conditions. Believe me, it happens. And believe me, it hurts, even though you keep your salary.

This doesn't explain why students of public health are also so hesitant and so are their faculties. I'd give you a good explanation for this--if I had one. I don't. But among both students and faculty I've seen it for forty years. There is a lack of political engagement, except at the most mundane levels of citizen advising or occasionally lobbying of the powers that be. But real activism? Very little.

But exceptions exist, and despite appearances I would go further and claim that heroes abound in public health. They come in two kinds: noisy heroes and quiet heroes. Noisy heroes, the ones that create a ruckus, rock the boat, become a pain in the ass to health departments and federal agencies, are indeed rare but extremely important. Because of their visibility they get recognition (which they deserve). But just as important are the "quiet heroes," the ones that go about doing the best job they can under increasingly adverse circumstances. They compromise when they have to and take advantage of opportunities when they can to advance the mission. They do it day in and day out and without any recognition or any expectation of recognition. Some are receptionists who makes an effort to see that any citizen who calls gets connected to the right person to answer their question. Some of them are that person who gives the citizen the best and most honest information they have, despite an organizational culture that discourages it. Some of them are managers who try to make the best of a bad situation to get as much of the job done as they can. They are the backbone of public health and without these quiet heroes, who somehow manage to retain a passion for public health, we would be even worse off--far worse off--then we are now.

How do you nurture "heroes"? Here are some of Peter's suggestions, aimed more at producing the more visible kind of hero:
What's a student of public health to do?

Here are some suggestions for you to consider:

1) Inform yourselves about the role of inequalities in public health [see Peter's newsleetter for discussion and references on this]

2) Inform yourselves about the official positions that public health professional associations have taken. To see relevant position statements by NACCHO, the National Association of County and City Health Officials, go here and search on NACCHO.

3) Develop a strategy for being effective, consistent with your professional goals, your personality, your ethical beliefs, and so on:

a) You might choose to remain a maverick working on the periphery of public health, but focusing on public health goals.

b) Or you could become a public health insider but build a constituency of people who values your work and would come you your aid in time of need;

Your constituency might include

** the people who are being harmed

** cultural creatives

** journalists ** community activists ** occupational health specialists ** nurses ** physicians

(Others? Let's brainstorm about this.)

c) Join, support, and protect your union AND the right of EVERYONE to form and join a union, to bargain collectively and, if all else fails, to strike. Labor unions -- for all their faults -- are the single most powerful force holding inequalities in check. In this way, unions are an essential and critical component of any successful public health program.

d) Join, work within, and support your professional associations, NACCHO, APHA [American Public Health Association] -- and similar associations at the state level.

e) Learn about whistle blowers and their survival strategies.

f) Work to change the culture of public health so that a public health worker who had important information but who did NOT speak out would feel ashamed and might even feel reproach from colleagues.

How could we change the culture of public health to make the default assumption not silence but an obligation to speak out and to advocate for what we know is right for public health?

Now let's brainstorm about that . . .
Yes, let's brainstorm about that. We need to make noise, the more noise the better.

But let's not forget the "quiet heroes."

Tuesday, April 26, 2005

Regulatory apocalypse?

There are a lot of bad things out there, but some of them are probably worse in terms of number of people affected. Global warming is probably worse than asbestos, avian flu is probably worse than Marburg virus. Not for the people affected, of course. Bush administration policies are like that, too. Pretty much all bad, especially for the people affected, but some are unbelievably bad-- bad like an avian flu pandemic is bad.

Consider the looming threat of the Sunset Commission, as highlighted by a chilling article in Rolling Stone by Osha Gray Davidson. Never heard of the Sunset Commission? You aren't alone.
If you've got something to hide in Washington, the best place to bury it is in the federal budget. The spending plan that President Bush submitted to Congress this year contains 2,000 pages that outline funding to safeguard the environment, protect workers from injury and death, crack down on securities fraud and ensure the safety of prescription drugs. But almost unnoticed in the budget, tucked away in a single paragraph, is a provision that could make every one of those protections a thing of the past.

The proposal, spelled out in three short sentences, would give the president the power to appoint an eight-member panel called the "Sunset Commission," which would systematically review federal programs every ten years and decide whether they should be eliminated. Any programs that are not "producing results," in the eyes of the commission, would "automatically terminate unless the Congress took action to continue them."
Like what kinds of federal programs?
[T]he commission would enable the Bush administration to achieve what Ronald Reagan only dreamed of: the end of government regulation as we know it. With a simple vote of five commissioners -- many of them likely to be lobbyists and executives from major corporations currently subject to federal oversight -- the president could terminate any program or agency he dislikes. No more Environmental Protection Agency. No more Food and Drug Administration. No more Securities and Exchange Commission.
Well, maybe it wouldn't be that bad. There's allegedly lots of waste in government programs and a Commission could get rid of it. Right?
The man behind the sunset commission is Clay Johnson, the most influential member of Bush's inner circle whom you've never heard of. The two Texans have been close friends since 1961, when they met as fifteen-year-olds at Andover prep school and later roomed together for four years at Yale. When Bush was elected governor of Texas in 1994, he put the buddy he calls "Big Man" -- Johnson is six feet four -- in charge of all state appointments. Johnson, a former executive at Neiman Marcus and Frito-Lay, refers to Americans as "customers" and is partial to Chamber of Commerce bromides such as "We're in the results business." He is also partial to giving corporate lobbyists a direct role in gutting regulatory protections. One of his first acts in Texas was to remove all three members of the state environmental-protection commission and replace them with a former Monsanto executive, an official with the Texas Beef Council and a lawyer for the oil industry. Overnight, a commission widely respected for its impartiality became a "revolving door between the industry lobby and government," says Jim Marston, the senior attorney in Texas for the nonprofit organization Environmental Defense.


Given its political gains last November, the administration is optimistic about winning approval in Congress. "The stars and the planets are aligned," Johnson recently declared, citing the solid Republican majority in Congress and the need to curb the soaring federal deficit.
So if the threat of a right-wing take over of the judiciary isn't scary enough for you, read Davidson's piece.

As I said, avian-flu-pandemic-bad.

Monday, April 25, 2005

Bioterrorism, an "overarching goal" of CDC?

The Press Release says, CDC Readies for 21st Century Health Threats. Since we are already 5% through the 21st Century I guess "getting ready" is appropriate. But ready how and for what?

For at least a year the effects of the announced reorganization have been turning CDC upside down, or maybe I should say, inside out, because a distressingly large proportion of senior management headed from the inside to the outside. I'm not sure the exits were adequate to accommodate the throng. Despite many warnings CDC Director Gerberding, like her boss in Washington and his Iraq debacle, was determined to move ahead and she did. Dr. Gerberding's bedside manner amounted to telling her (now former) colleagues, "Deal with it."

The new structure has four "coordinating centers"; and two new national centers, one called the The National Center for Health Marketing. Nice. Health marketing.
"CDC is now a 21st-century agency ready for the challenges of 21st-century health threats," said CDC Director Dr. Julie Gerberding. "Any corporation or large organization will tell you, realignments are typically tough to achieve. The exciting part is the payoffs we're already seeing as we emerge from this initiative as a modern, flexible, goal-oriented agency."
Payoffs, as in "assuring a flu vaccine supply"? Or "assuring a proper safety level for H2N2 flu virus"?

And goals?
CDC's two overarching goals are to prepare for terrorist health threats and, at the same time, protect the health and quality of life across the entire lifespan of all Americans from reducing perinatal problems such as low birth weight to preventing heart disease and stroke in older Americans.
So CDC has two goals: (i) bioterrorism and (ii) the rest of public health.

As they say, it's all about balance.

Sunday, April 24, 2005

Pope Benedict (N-1) and influenza

Much is being made (see, for example, the wikipedia entry) of the new pope's choice of professional name, Benedict XVI, particularly the allusion to the previous Benedict (XV):
. . . the previous Pope Benedict XV was seen as a conciliator who calmed the disputes between modernist and traditionalist factions with the Church, and the adoption of the name Benedict has been seen as a sign that Benedict XVI has similar goals. Additionally, Der Spiegel reports on an interview with Cardinal Meisner, usually regarded as close to Ratzinger, stating that he chose Benedict because of Benedict XV who "did much for peace in the world".


However, John Allen, the new pope's biographer and a longtime Vatican observer, told CNN on April 20, 2005, that the choice of name also appears to be a purposeful allusion to the fact that the previous holder of the name Benedict was shortlived in office. Ratzinger's brother has stated that he hoped that his aged brother would not be elected to the papacy due to the pressures of the office and the fact that in 1991, Cardinal Ratzinger suffered a brain hemorrhage. Given this history, Allen noted, "So I think he has a very keen sense that this may not be a very long pontificate and there's an awful lot to do."
I won't weigh in on theological matters, here, but can't resist making some historical observations about the previous Benedict, Giacomo della Chiesa, (November 21, 1854 – January 22, 1922), who was Pope from September 3, 1914 to 1922. della Chiesa succeeded Giuseppe Sarto (professional name, Saint Pius X), who himself was extremely conservative, condemning the "modernist" agenda of trying to assimilate "modern philosophers like Kant" into church doctrine. Both della Chiesa and Sarto were staunchly opposed to WWI (as Wojtila was opposed to the Iraq war) and both were strongly anti-Socialist, as was Wojtila (see the Encyclical Ad Beatissimi Apostolorum - Appealing for Peace - 1 November 1914). So there are clear historical parallels.

A parallel we hope doesn't hold is that della Chiesa (Benedict XV) was pope during the 1918 - 1919 influenza pandemic and in fact died of influenza complicated by pneumonia at the age of 67 in 1922.

Sunday Freethinker Sermonette

Wherein we deliver a little homily:
Stephen F. Roberts

“I contend that we are both atheists. I just believe in one fewer god than you do. When you understand why you dismiss all the other possible gods, you will understand why I dismiss yours.”

Saturday, April 23, 2005

Pandemic in slow motion?

It seems to be dawning on Vietnamese and WHO officials that the bird flu pandemic might already be on us. In today's Washington Post we read about the good news/bad news picture of a disease, influenza A/H5N1, becoming less lethal while at the same time perhaps becoming more widespread and easily transmissible. We raised this scenario here, here and here, and Henry Niman at Recombinomics has been hinting at the same thing, pointing out the larger clusters and reduced mortality of the northern Vietnamese cases compared to the southern ones. Now WaPo is catching up:
"The virus could be adapting to humans," said Peter Horby, an epidemiologist with the World Health Organization in Hanoi, the Vietnamese capital. "There's a number of indications it could be moving toward a more dangerous virus."

The mortality rate for bird flu in Vietnam this year is about 35 percent, almost exactly half that of last year, according to Health Ministry statistics. The mortality rate of the 1918 Spanish flu pandemic, by comparison, was less than 5 percent, but the outbreak killed an estimated 40 million people worldwide.

Officials said the drop in the bird flu mortality rate was more marked in northern Vietnam than in the south. While the virus in southern Vietnam is still killing at the same pace as last year, the rate in the area around Hanoi and elsewhere in the north has dropped from that level to as low as 20 percent. Vietnamese health experts said their suspicion that the disease is shifting is further supported by preliminary research showing a genetic change in the virus in the north resulting in the production of a protein with one less amino acid than in the south.
To our knowledge this is the first mention of a genetic difference between northern Vietnam H5N1 and southern Vietnam H5N1. Reading between the lines, it suggests the polybasic cleavage site seen in highly pathogenic avian influenza is shorter in the northern variant. To be infective, the HA (hemagglutinin protein spike) on the virus must be cleaved by the host into two pieces, HA1 and HA2. The enzymes that can fit into the narrow cleavage site of low virulence viruses are found in the respiratory tract in humans or intestinal tract of fowls, but if the cleavage site is "opened up" by some extra amino acids, more tissues can accomplish this and hence become vulnerable to infection, leading to pantropism, that is, infection of many organ systems besides the lung. Thus the nervous system, kidneys and other organs also start to fail rapidly in human infections with H5N1. If this is the nature of the genetic differences, it might mean that the northern variant is less prone to involve other organ systems.

But lower virulence H5N1 is not avirulent H5N1. In addition, much is not known of the specific virulence factors. Moreover, some flu experts think that the virus adapts further once it takes hold in the human population, with the second wave of a pandemic more severe than the first, as happened in 1918 - 1919. Even if the mortality is as low as 5% (probably the upper limit for mortality in 1918 flu), since there is essentially little natural immunity to H5N1 (except an unknown amount against the N1 component), a pandemic could infect 20% to 30% of the world's population, or 1.5 billion people. If only half of those became clinically ill and 5% of those died, it would amount to 40 million deaths, worldwide, roughly 130 Indian Ocean tsunamis.

The early signs of most pandemics are visible if you are watching closely. If you aren't, they seem to burst on the scene with scores, hundreds and then thousands of cases. Maybe CDC and WHO are watching closely. But they have waited so long to turn the wheel, now it is a bit like an auto accident that seems to be happening in slow motion without any ability to do anything but brace ourselves to spin out of control.

Blogrollin' Friday (Saturday edition): Diderot's Lounge

It's the Saturday version of Friday again (the announcement of Judging the Future blog pre-empted this slot yesterday) and time to heed PSoTD's injunction to highlight another blog. This is a good one.

This week I received an invitation to visit Diderot's Lounge. Although not specifically a "public health blog" it seems inhabited (if I can use that phrase in this connection) by people with a public health interest, at least to the extent some are part of the Spirit of 1848 listserv, a venerable progressive public health medium of information exchange. What attracted my interest was a series of exchanges about the last pope from a public health and social justice perspective.

As might be expected it involved Catholics, who had some fairly strong (and not very complimentary) views. As a non-Catholic (and non-believer) I was aware of Wojtila's conservative reputation, but was unfamiliar with the extent and depth of his deeply reactionary history. The current pope, as the last one's enforcer, also comes in for some unfavorable comment.

Three lengthy posts on the subject can be found at Diderot's Lounge here, here and here. They begin with a statement from Johns Hopkins Professor Vincente Navarro, well known to many of us for his long history as a theoretician of progressive health care policy. Here is an excerpt from Vincente's first post:
Dear Colleagues,

It is not customary for me to write on Church affairs. Most of my work is concerned with how to eliminate poverty and reduce social inequalities in the world. But I am outraged by the way the U.S. media have portrayed the deceased Pope. I am enclosing an article I have written recently published in Counterpunch which aims at setting the record straight. Needless to say, my influence is remarkably limited, since my access to the media is nil. I hope, however, that people involved in correcting health and social inequalities will help to correct the record.

John Paul II's opposition to the war in Iraq should not mask his reactionary positions on both religious and social issues. Despite his portrayal as such in the media, he was no friend of the poor. He opposed those who tried to resolve poverty, such as the Latin American liberation theology movement. He supported regimes responsible for expanding poverty. When he visited Chile during the Pinochet regime, he never publicly condemned or criticized that horrible dictatorship. To the contrary, when Pinochet was detained in London at the request of the Spanish Judge Baltasar Garzon--who wanted Pinochet to be tried in Spain for the assassination of Spaniards in Chile--John Paul II's Secretary of State, Monsignor Soldano, pressured the British government to release him.

There is much else of interest in this three part airing of views. If you are interested in the papacy and its history and influence, or just want a palate cleanser from the diet of papacy pap being shoved down our gullets by the MSM, give it a look.

Diderot's Lounge seems an interesting site. I'll be checking it often and it now appears on my blogroll.

Friday, April 22, 2005

How much bird flu in Vietnam?

Thanh Nien News is reporting today that Vietnam is increasing its hospital capacity to handle patients with bird flu. Official reports note the difficulty of eradicating the poultry epidemic and blame sporadic human cases on failure to implement safety standards and public ignorance. But actions on-the-ground seem to tell a different story:
Five more hospitals in Vietnam will be furnished with new equipment able to handle H5N1 patients, bringing the total to 12 nationwide, the Health Ministry said.

Also, the ministry has asked for reinforcement of measures to quickly control the epidemic.

Specifically, localities have to strictly supervise fowl farming and transport at households in order to discover newly-hit places.

Provinces and cities along borders must check people from neighboring nations affected by the disease when they enter the country as well as monitor fowl transport across the border.
We note that Henry Niman at Recombinomics reported last week that nearly 1000 blood samples were sent to CDC, although how many were human and how many were poultry or other animals is unclear. There is still no information on the results of tests on the nearly 200 reported flu-like cases from Quang Binh, leading Niman to suspect that widespread infection has been detected.

If WHO and Vietnamese authorities have information to the contrary they had better get around to saying it.

Friday Blogrollin': Judging the Future

Melanie Mattson of Bump in the Beltway fame has just announced a significant new blog, Judging the Future. This from the Intro post:
Welcome to Judging the Future, a project of Bump in the Beltway productions and a progressive, independent voice on judicial nominations issues. All opinions expressed here are those of the individual contributors and not necessarily those of any sponsors unless otherwise noted.

This site is for activists: when we raise an issue, we'll give you something to do far beyond wringing your hands. Come on in, and let's have a little fun taking our country back from the neo-cons and right-wing radicals in Congress.

We will obviously be paying special attention to President Bush's judicial nominees. This is, in my eyes, the single most important public policy issue before the people of this country right now. These lifetime appointments are our bequests to the future. Constitutional checks and balances are all that are standing between us and a rubberstamp judiciary that will ratify every thing that the radical rightwingers in Congress push through.

You'll be seeing announcements of events you can take part in to make your presence felt and your voice heard. We are going to be making news here, rather than simply reacting to it.

In a month or so's time, we'll be moving this site to a new platform, Expression Engine, to give us greater community-making capabilities. We expect to grow quickly.

Respectful comments are encouraged, the First Amendment is one of our core values. Abusive or obscene comments will be deleted, however.

Yer bloghostess is a DC policy wonk with an eye for progressive politics, a sense of humor and a rather snarky sense of the way everyone in DC takes themselves SO seriously.

Thanks to Earthjustice and other members of the Coalition for a Fair and Independent Judiciary for their input and support in getting this project off the ground.
Keep an eye on this one (and do it daily!). This will be one of the A-list blogs in no time at all and what it is doing couldn't be more important. Melanie is a formidable blogger with the acumen, sensibility and energy to make a difference. But she can't make a difference without us. So head over to Judging the Future so the future doesn't wind up judging us.

Thursday, April 21, 2005

WMDs everywhere

Iraq is chock-a-block full of Weapons of Mass Destruction (WMD). So is New York. At least they are if you use the definition of WMD favored by the Department of Justice: WMDs include "any destructive device." This statutory definition emerged in the indictment of three British nationals for conspiring to use WMD announced last week in New York (via The Secrecy Project):
At a press briefing on the indictment, an alert reporter asked Deputy Attorney General James B. Comey exactly which "weapons of mass destruction" the individuals had conspired to use.

"Is there any implication in the use of that term that there was a biological or a chemical or a radiological element to the plan?" the reporter inquired.

"We have not alleged that," Mr. Comey replied.

But, he added, "a weapon of mass destruction in our world goes beyond that and includes improvised explosive devices."
18 U.S.C. 2332a was the cite to support this. I guess that's one way to show you were right after all.

[NB: post date corrected. Blogger keeps misbehaving on dates!]

Wednesday, April 20, 2005

Tangled Bank is up: Special Anniversary Edition

Coturnix is hosting the Special Anniversary Edition of Tangled Bank, the venerable (in blog terms) compilation of the best recent science posts on the net. A huge pile of great posts starting with TB's founder PZ (Pharyngula) on how to make a vulva (Warning: This is for professionals. Don't try this at home). Scroll down and you will find us in the crowd. But read the rest. They're great.

Better than even is bad

In a move that belies some optimistic rhetoric from Vietnam, the ban on poultry farming previously covering Ho Chi Minh City (formerly Saigon) is now being extended to 15 cities and provinces (including Hanoi), in an effort to stem the stubborn tide of avian influenza (via The Australian). Small live poultry markets will be replaced by large slaughterhouses with a complete ban on free-range breeding of waterfowl. Beginning in August the government will pay for compulsory vaccination of poultry in high risk areas. Despite strict regulations, enforcement is inconsistent and spotty, with reports of live poultry roaming freely in areas of Ho Chi Minh City despite the ban (Bloomberg).

While Vietnam now claims all but one of the 35 afflicted provinces and cities (of 64 total) are clear of the disease, human cases continue to occur. The recent announcement of three more cases, including a double infection of H5N1 and HIV, underscored the problem (via CIDRAP). The explanation would thus seem to be either that the reports of eradication among poultry are incorrect (which is almost certainly the case) or that the disease has another reservoir, possibly human. Moreover experts on the scene are now intimating that the situation is changing:
Peter Horby, the WHO medical epidemiologist in Hanoi, said that while the mortality rate from H5N1 infections was falling, the virus appeared to be adapting to human hosts, which was taken to be an indication that transmission between humans would become easier.

"The fact that it's been around for a year and we haven't seen a pandemic is no reason to be complacent," he said.

"I'm more concerned than I was a year ago." He estimated the probability of a pandemic at "more than 50 per cent".

Dr Klaus Stohr, the WHO global influenza programme chief, reported an increase in the number of cluster cases reported recently, with the biggest a family of five cases.

There have been seven cluster cases in Vietnam, all within single families, most recently in the northern province of Haiphong.

No relative has been proved to have passed the disease to another, but Dr Horby said: "The onset dates could be consistent with human to human transmission." (The Telegraph [UK; my emphasis])
"More than 50%." That's better than even. And that's bad.

Addendum: Reuters (via is reporting that a 20 year old Cambodian woman has been rushed to a hospital in Vietnam with suspected bird flu. The victim is from Kampot province, bordering Vietnam, where three other confirmed cases and one unconfirmed case have previously been reported. Relatives say chickens near her home had died of unknown causes but there is no other information on exposure. Thus bird flu continues to smolder in southeast Asia.

Update (4/20/05, 7:38 am EDST): icWales and other sources now report the young woman has died. Prior to this the unofficial tally (CIDRAP) in the latest outbreak (since mid-December 2004) at 19 deaths out of 44 cases. Whether this latest death will be entered in the tally will depend upon the outcome of tests for H5N1. It sounds as if this is the likely diagnosis, however.

Tuesday, April 19, 2005

"More than overdue." What is there to deliberate about?

The errant and "inappropriate" shipment of influenzaA/H2N2 hastily recalled by WHO and CDC over the last week seems mostly accounted for. Mostly. Missing shipments to Lebanon, Mexico and Chile have reportedly been found in a FedEx warehouse, but not all shipments within the US have been located as of this date.

A few questions remain, however. One is the nature of the virus, which has been variously reported as virtually identical to the pandemic virus of 1957-58 (via the reliable Helen Branswell at Canadian Press) or as H2N2/Japan, a vaccine reference strain whose virulence may (or may not be) less than the circulating pandemic virus according to the less reliable Wendy Orent in WaPo). No one knows if the virus is less dangerous than the original nor is it completely clear it is really a "reference strain." Reference strains made in the 1970s and later are reassortants of the HA and NA genes from the circulating virus with influenza A/PR8, a high growth strain used to make vaccines in embryonated eggs. But H2N2/Japan seems to be a strain from the original epidemic that has been passaged frequently in laboratories, and as a result, "may" (or may not) be less virulent.

Another question relates to how a patient's unrelated specimen managed to become contaminated by this virus in an (as yet unidentified) lab in Vancouver. The cross contamination was fortunate, in the sense that the patient's specimen was analyzed more thoroughly than would have been the case for the original proficiency test sample, which only required it be identified as influenza A. But it leaves open the question of how, physically, the contamination occurred. CDC and WHO are busy telling us that accidental infection of a lab worker is very unlikely because they are highly trained and chances of exposure are miniscule. How, then, did the patient's specimen become contaminated?

The third, and perhaps most important question, relates to why H2N2 is handled under biosafety level 2 (BSL 2) conditions in the US ("good laboratory practice") but requires BSL 3 protection in Canada (use of safety cabinets and other protections). CDC Director Gerberding explained that because influenza isn't a bioterrorist agent, it did not receive the proper attention. Besides showing unbelievable stupidity, incompetence and a blind sense of misplaced priorities, we note that despite Canada's pleas and WHO's dismay the US has still not taken the required step of classifying H2N2 as a BSL 3 agent:
The head of the WHO's global influenza program said Wednesday that countries which have not already done so should upgrade the biosafety level applied to the flu strain that laboratories around the world are racing to destroy because of its pandemic potential.

"Now it's more than overdue perhaps to review the situation, the biosafety levels that are being attached to this virus," Dr. Klaus Stohr of the World Health Organization told The Canadian Press in an interview from Geneva.

Dr. Julie Gerberding, director of the U.S. Centers for Disease Control, suggested authorities in the U.S. will speed forward with deliberations over a recommendation that the strain, known as H2N2, be upgraded from a Level 2 biosafety grade to a Level 3, as it is in Canada.

The scientific director of Canada's National Microbiology Laboratory said the U.S. ought to take that step.

"It's clear that this H2N2 virus should be a Level 3 virus to me and I think that's what will happen in the United States," Dr. Frank Plummer said in an interview. (Helen Branswell)
So CDC will speed forward with deliberations. What is there to deliberate about?

Monday, April 18, 2005

Carnival of the un-Capitalists now up

I'll skip the "come one, come all" intro traditional for Carnivals and just tell you that a really terrific collection of links (including one from here, naturally) on "health care marketing" is up over at the redoubtable Majikthise. This should interest all public health folks interested in access to care, health care finance, health care delivery or just plain social justice. It even interested Revere!

Come one, come all. (Wait. Skip that.)

ChoicePoint award winner

ChoicePoint, the data broker that Taser International is entrusting with doing background checks on the civilian purchasers of their stun guns and who sold a 145,000 of our personal records to identity thieves (a trivial portion of their estimated private collection of 19 billion items of citizens' personal information) has been justly recognized by Privacy International with a Big Brother Award. This marks the second time the company has been honored by the organization, having garnered the Greatest Corporate Invader award in 2001.

Congratulations to all concerned. I think anyone who knows anything about ChoicePoint will agree: they truly deserved this award.

Sunday, April 17, 2005

"It is a bit like farming . . . . "

Many years ago (20?) I was asked by some folks making a show about contaminated water to come to Beverly Hills and be filmed in an informal setting with some other people I knew (the only one of which I can remember at this long remove is Lois Gibbs, the hero of Love Canal). Why not? I knew and respected Lois and it sounded like it might be fun.

And it was. With Mrs. R. and the two little reveres, off we went. Picked up by a limo, a nice hotel and then the show, with Lindsay Wagner (The Bionic Woman, now hawking beds on late night cable) and Henry Morgan (Colonel Potter from M*A*S*H). We chatted away, were asked a bunch of questions by the moderator about various "things people could do personally" if their water were contaminated, none of which we said were of much use. And that was that. We each got our pictures taken with the TV stars. As I said, it was fun.

Then I saw the show (which played over and over in the middle of the night around the country). It was an infomercial from a water filter company. Water filters were never talked about on the show. Just all the other things--the ones that didn't work.

I was reminded of all this when I saw a Commentary by Georgetown Medical School's Dr. Adriane Fugh-Berman in the Journal of General Internal Medicine (available here). Fugh-Berman is an authority on complementary and alternative medicine. She describes how she was approached by a Medical Education Company (MEC) hired by a pharmaceutical firm to put her name on a "draft" of a medical article on herb-warfarin interactions to be submitted to a scientific journal.

Warfarin is a standard blood thinner used in clinical medicine. For fifty years it has had almost no competitor. Interestingly, the "sponsoring" pharmaceutical company made neither warfarin or herbal remedies. Curious as to why they would be interested in publishing such a paper, Fugh-Berman received this reply:
This paper is a series of communications concerning the importance of anticoagulation therapy with warfarin for stroke prophylaxis, whilst simultaneously highlighting the difficulties and burden that such therapy places on the patient, clinician, and society. One such problem concerns warfarin’s high interaction potential, which can give rise to problems with anticoagulation control. Whilst there is no promotion of any drug within this paper, ABC Drugs is keen to set the scene for new anticoagulants that are not subject to the numerous limitations of warfarin.
Aha. The water filter gambit.

And it turns out that this whole scenario is quite common, although the true frequency of "corporate ghost authorship or coauthorship is unknown":
Some conflicts of interest are invisible. Pharmaceutical companies routinely seed medical literature with reviews or commentaries that advantageously frame a marketed drug, but some sponsored articles never mention the targeted drug. Both types of articles are usually written by a medical education company (MEC) that receives funding from a pharmaceutical company. Academic physicians are recruited to sign these articles.

The division of labor for such a corporate-sponsored article is rarely equal; although the signer is invited to make changes, the primary obligation of the academic coauthor is to claim authorship. The primary author from the MEC remains anonymous, and any instructions given to the primary author regarding tone or emphasis are not shared with the named author, who is usually paid by either the MEC or the sponsoring pharmaceutical company.


While a suspicious audience member may discount the objectivity of a speaker who talks about a product manufactured by a company for whom that speaker consults, some conflicts of interest are difficult to discern. Companies regularly fund articles and talks that never mention the targeted drug, but are meant to disadvantage the competition. One of my colleagues was paid handsomely by a drug company to give a hundred talks a year presenting negative data on alternative therapies, a competitor for an infinitesimal share of the market dominated by the company’s blockbuster drug. My colleague did not misrepresent the data, and there would be no reason for the audience to suspect that a talk that mentioned no pharmaceuticals was funded by a pharmaceutical company.
The big medical journals (Lancet, BMJ, JAMA, New England Journal of Medicine) also benefit by selling the drug companies reprints which are then distributed by mail to doctors. This is one of the reasons these journals oppose Open Access and require copyright from authors.

This is a fascinating Commentary about a technique most scientists and doctors little suspect and never think about, but who are its main targets:
These efforts may begin years before a pharmaceutical is approved for sale. It is a bit like farming; weeds are removed, the soil prepared, perhaps a cover crop planted, to be tilled under before seeds are sown in the receptive soil. Some MECs organize continuing medical education conferences, other specialize in writing articles, and some do both. [my emphasis]
Yes, it is "a bit like farming." Complete with manure.

Sunday Sermonette

[NB This is a corrected attribution that was in error. I originally confessed that my theft of the Sermonette idea was from Political Site of the Day (PSoTD), not James Wolcott. This was a natural error on my part because PSoTD has so many great ideas and he leaves his door open. But alas, the pilfered product belonged to that great stylist, M. Walcott. My apologies to both victims.]

Last Sunday, James Wolcott had a "Sunday Sermonette," a brief quote from Tom Paine (non-living proof that common sense isn't that common). The thrust, of course, was avowedly and devoutly secular. What a great idea, I thought. Why don't we all do this every Sunday?

Thus, the first of my Sunday Sermonettes:
“With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion.”

(Steven Weinberg; as quoted from Carey Goldberg, "Cosmology and Theology Tangle in a Rousing Match," The New York Times, April 20, 1999. Lifted off

Saturday, April 16, 2005

You can put the feeding tube in, now

The Bush Administration and Republican congress have finally reduced Federal occupational health and safety protection to a Persistent Vegetative State so I guess they feel it's OK to put in the feeding tube and use its empty shell for political purposes.

As evidence, Jordan at Confined Space tells us that the Republican Congress Things at the House Appropriations Subcommittee on Labor, Health, and Human Services and Education April 7 OSHA appropriations hearings were happier than pigs in shit, as reported by Jim Nash at Occupational Hazards:
Ostensibly the hearing was about the administration's fiscal year 2006 budget request, but the subject of money never arose as Republican members of the panel praised OSHA, the Mine Safety and Health Administration (MSHA) and the National Institute for Occupational Safety and Health (NIOSH) for emphasizing education, compliance assistance and other business-friendly voluntary programs.

"We didn't get a lot of complaints about OSHA, so you must be doing something right," Ralph Regula, R-Ohio, told Acting OSHA Administrator Jonathan Snare, after Snare completed his testimony. Regula chairs the House Subcommittee on Labor, Health, and Human Services and Education.

"I think MSHA is doing a wonderful job," asserted Rep. Don Sherwood, R-Pa., another subcommittee member. Sherwood praised the agency, and Acting Administrator David Dye, for working with employers and miners to improve safety by offering compliance assistance while "still getting the production out."
Jordan, as always, nails it:
One thing you can be confident of in Washington is that when Republicans are happy with what OSHA's doing, it's a sure sign that the agency isn't doing what it's supposed to be doing: protecting workers.

[NB: Posting date corrected]

Friday, April 15, 2005

Blogrollin' Friday: The Rest of the Story

It's been a few Fridays since we did a Blogrollin' one, so I'll remind you of the idea, due to PSoTD. Instead of posting the usual pictures of your cat (nothing against cats except that I don't care for them), we use Friday to highlight another blog we like. As PSoTD pointed out, it builds community.

So here it is: an almost new public health-oriented blog, The Rest of the Story. What story? The sordid story of Big Tobacco. Endlessly appalling and infuriating yet with the fascination of a horrible highway wreck. Here's the official announcement:
Announcing the launch of a new tobacco news blog entitled:
The Rest of the Story: Tobacco News Analysis and Commentary

This blog will provide analysis and commentary of current issues, research, events, and programs in tobacco control, with an eye towards revealing the full story behind the news and its overall significance to the public health practice of tobacco control.
Wednesday's top story was about "Kick Butts Day, a national day of youth advocacy on the tobacco issue run by the Campaign for Tobacco-Free Kids. The Campaign is asking youths throughout the country to 'Stand Out, Speak Up, and Seize Control in the fight against Big Tobacco.' " Sounds pretty good. Now read The Rest of the Story.

Trouble in the House of Plastic

Fred vom Saal is a highly respected scientist at the University of Missouri. If he suffers any lack of respect it is in the House of Plastic. In the House of Science he's in good shape. So I take with a grain of, well, plastic, the fact that the Family of the House of Plastic is upset with his new paper, just published in Environmental Health Perspectives.

The paper reviews a large body of recent literature on low dose effects of a ubiquitous environmental chemical almost all of us carry around in our bodies. It has attracted media attention because he and his co-author, Claude Hughes, show quite clearly there is an iron-clad relationship between funding source and outcome of a particular body of literature. As striking as this is, there is much more of significance in this wide-ranging review, and I shall try to highlight a bit of it. For those interested, it is freely available on-line at EHP.

A bit of background. In 1997 vom Saal sounded the alarm about very low doses of estrogenic chemicals, including a chemical used to make plastics, bisphenol A (BPA). BPA monomer units are strung together to make polycarbonate plastic, a resin lining most food and beverage cans and the substance of certain types of plastic beverage bottles, including the popular tinted bottles used by joggers, outdoor enthusiasts and many others. It also appears as an additive in many other products and is produced in huge quantities worldwide (6.4 billion pound capacity and growth of over 6%/year). The ester linkages between the monomer units are relatively weak, however, and the heat of sterilizing cans or acid or basic foodstuffs can hydrolyze the linkages, breaking the chains apart and releasing BPA. Ninety-five percent of urine samples in a recent CDC population survey had measurable levels of BPA. Thus the thought that extremely low doses of this chemical could be a problem immediately raised the ire of the 15 companies that make or use BPA and their trade association (the American Plastics Council).

The low doses we are talking about are indeed low, so low that some people don't find it credible they could be harmful. In fact it is biologically quite plausible. Consider the developing fetus or a fetal organ like the central nervous system. The process of growth and development is extremely intricate and requires precise coordination between some cells that grow, others that don't and still others that commit suicide (programmed cell death or apoptosis). Remodeling an organ is an example where some cells die while others preferentially grow. Growth and development is like a delicate dance where the different tissues act and respond in specific ways and in a specific order. Even doing the same thing but in the wrong order can be a recipe for failure, like putting on your shoes first and your socks second.

For growth, development and many essential physiologic processes cells and tissues need a way to communicate. The two main signaling systems are electrical (the nervous system) and chemical (the endocrine or exocrine systems). The endocrine system involves secreting minute amounts of a signaling chemical (a hormone) which travels through the blood and interacts with a target tissue via receptors on the target tissue cell. The signalling hormones are active at extremely low doses, doses so low that it was only in recent decades that technology was available to measure them.

One of the main concerns about endocrine disrupting chemicals is that they are like noise or static disrupting this essential communication process. Consider sitting in a crowded bar, trying to say something important to a companion while crowd noise, a blaring TV and a band play close by. As we all know, the sea of noise makes communication difficult and error prone. The same thing happens when we are bathed in a sea of endocrine-like chemicals, a kind of hormonal noise. BPA is a large contributor to that noise.

In their paper vom Saal and Hughes review 115 published studies of BPA and report that 94 show biologically significant effects at low doses. The "source of funding" finding regarding these papers is the most quoted, so we'll do it too:
As of the end of 2004 we are aware of 21 studies reporting only negative results with low doses of BPA. Source of funding is highly correlated with positive or negative findings in published articles. For government-funded published studies, 94/104 (90%) report positive effects at doses of BPA below 50 mg/kg/day. No industry-funded studies (0/11 or 0%) report positive effects at these same doses.
The authors also analyze several of the industry studies, convincingly showing how the work was flawed. At the same time, they are highly critical of the use of conventional toxicological methods for endocrine-disruptor risk assessments:
The implications of these results extend beyond BPA, because they may lead to requirements that hazard assessments be designed to detect analogous low-dose impacts of other chemicals. Acknowledgement of the existence of the large number of studies showing unique low-dose effects of BPA could lead to the demand that in designing studies to assess the hazards of all chemicals for risk assessment purposes, a wider range of doses must be examined, as opposed to only a few very high doses based on the maximum tolerated dose. This would require accepting that extrapolation from data on effects at very high doses (based on the linear-threshold model) is not valid for endocrine disrupting chemicals.
They conclude a new risk assessment for BPA is overdue, based on:
1. The extensive new literature reporting adverse effects in animals at doses below the current reference dose,

2. The high rate of leaching of BPA from food and beverage containers, leading to widespread human exposure,

3. Reports that the median BPA level in human blood and tissues, including in human fetal blood, is higher than the level that causes adverse effects in mice, and

4. Recent epidemiological evidence [a case-control study of polycystic ovary in Japan] that BPA is related to disease in women.
Ironically, while the industry has been training their fire on vom Saal, the scientific community has been busy finding new and additional mechanisms of BPA biological action at extremely low dose (see, for example, Wozniak et al. in this month's EHP where effects on Ca+2 flux and prolactin release are demonstrated at pico- and nanomolar concentrations).

The paper by vom Saal and Hughes may represent a watershed in the scientific approach to endocrine disrupting chemicals. It is powerful and persuasive reading.

Thursday, April 14, 2005

"Don't worry, be happy"

As CDC and WHO scramble to pick up the pieces of the pandemic influenza virus laboratory fiasco, they have reverted to usual spin mode, even as they admit they don't know what's going on.

Here's the CDC dance (AP via MSNBC):
The agency said it didn’t know why such a dangerous strain was included as part of the testing process.

“There’s a lot of questions right now we don’t have answers to,” said spokesman Tom Skinner. “I think what people need to understand is the very labs that receive these strains of influenza all have people trained to work safely and effectively with these viruses....”
Oh, right. "Safe and effective" like this:
In the United States, the samples were sent [by the] College of American Pathologists and for the moment, WHO said it was unsure how many samples had been destroyed there so far.

[WHO's Klaus] Stohr said the company which sent out the virus samples — Meridian Bioscience Inc. of Newtown, Ohio — abided by current U.S. regulations.

A spokesman for Meridian said company officials were traveling and not immediately available for comment.

However, Dr. Jared Schwartz, an official with College of American Pathologists says Meridien didn’t know it was a pandemic virus they sent out, they just thought it was an ordinary flu virus. He said they went to their samples and found a virus from the year 2000, which they’d gotten from another company which had gotten it from yet another company. According to Meridien’s process and evaluation they thought it was “an innoucuous. typical influenza A virus, the kind of virus they’ve used before in our programs,” Schwartz said.
So why aren't influenza viruses treated more carefully?
The head of the U.S. health agency said Wednesday that the government should restrict the handling of flu virus to more secure labs, as thousands of scientists around the world destroyed a deadly flu strain that had been sent to thousands of labs for testing.

Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention in Atlanta, said the agency has already recommended that change — a step not previously taken because flu virus has never been considered a possible bioterrorism weapon.
This makes me want to scream. They didn't do it because it wasn't a BIOTERRORISM weapon? WAKE UP. There aren't any bioterrorism weapons around. There ARE a lot of naturally occurring agents that kill people every day.


Wednesday, April 13, 2005

Take a deep breath--hold it. Don't breathe.

Jordan Barab has a great post over at Confined Space about CongressThing Roger Wicker, Republican from Mississippi (Mississippi--reminds me of a Phil Ochs song).
Wicker is the Congressman from Mississippi whose focus in life seems to be making sure that health care workers get exposed to tuberculosis (TB).


A little background, in case you don't recall. When OSHA issued its new respirator standard in 2000, they didn't cover health care workers exposed to tuberculosis because they were going to be covered in the new tuberculosis standard. When Bush's OSHA killed the tuberculosis standard at the end of 2003, the agency (correctly) decided that health care workers who may be exposed to TB would be covered under the general respirator standard (like every other worker who wears a respirator) and required to have annual respirator fit tests (like every other worker who wears a respirator.) Ask any industrial hygienist: respirators don't work real well if they don't form a tight seal around the face. OSHA has estimated that 5 percent to 50 percent of workers would lack a proper fit without annual testing.
The American Hospital Association and the Association of Professionals in Infection Control (APIC) don't want the bother of fitting their workers with adequate protection. Perhaps not coincidentally, Congress Thing Wicker introduced a rider to prevent OSHA from enforcing the standard for health care workers. As Jordan tells us, riders only go for a year, and Wicker's attempts to make the waiver permanent were unsuccessful (details in Jordan's post). Jordan expects him to come back for another rider.

Read the post. Then tell Congress Thing Wicker, the AHA and the APIC to go fuck themselves. Using condoms, of course. We wouldn't want them to get infected.

Fever pitch

Wayne, over at Niches. got the flu or at least a flu-like illness. Being a good naturalist, he recorded the event for blogsterity, including a detailed record of his rectal temperatures, along with very instructive annotations. The fever chart and his own clear-eyed post indicate he is well on the road to recovery.

The only thing I would add to his "functions of fever" explanation is that another consequence of fever is that it slows us down dramatically and decreases our appetite. Thus we don't waste energy on moving or digesting and can devote more to fightng the infection via the immune system. A great post. Go read it.

Tuesday, April 12, 2005

Cleaning the fridge of pandemic virus

What would you call it if a pandemic flu virus that killed several million people was sent to 5000 laboratories in 18 countries as part of a routine kit for quality control and certification purposes (meaning it might be handled by relatively inexperienced personnel)? How about, "major fuck-up."

The 1957 influenza A/H2N2 pandemic strain hasn't been in vaccines since 1969, so anyone under the age of 37 would likely have no immunity to it. The company apparently responsible is Meridian Bioscience Inc. of Cincinnati, Ohio who was in charge of preparing the kits for the College of American Pathologists. From their website:
Influenza A Virus- Influenza A Virus Antigen (Etiologic)
  • Lyophilized specimen for antigen detection.
  • Each lyophilized specimen is comprised of a rubber stoppered glass vial containing a freeze dried virus infected cell suspension and fitted with an aluminum crimp cap.
  • Each specimen is labeled per specifications.
It's unclear how long the vials have been at the laboratories or whether they have already been used anywhere. The last shipment was said to be in February.
“The risk is relatively low that a lab worker will get sick, but a large number of labs got it and if someone does get infected, the risk of severe illness is high and this virus has shown to be fully transmissible,” said the WHO’s influenza chief, Klaus Stohr. (The Scotsman)
CBC reports Canadians were the first to recognize the danger. Ninety-nine percent of the kits went to labs in the US, except for 20 to Canada and 61 that went to labs in 16 other countries in Europe, Asia, the Middle East and South America. WHO won't identify the other countries that received the samples. That's comforting.
The test kits are used for internal quality control checks to demonstrate that a lab is able to correctly identify viruses or as a way for labs to get certified by the College of American Pathologists.
The kits involve blind samples. The lab then has to correctly identify the pathogen in the vial in order to pass the test. Usually, the influenza virus included in these kits is one that is currently circulating, or at least one that has recently been in circulation.

On March 26, National Microbial Laboratory Canada detected the 1957 pandemic strain in a sample not connected with the test kit. After informing WHO and the CDC of the strange finding, the lab investigated. It informed the U.N. health agency on Friday that it had traced the virus to the test kit. (Emma Ross, AP, via Kansas City Star)
Thus the kit is an unlabeled "unknown" the lab is supposed to identify correctly. The company was instructed to select a virus from its inventory and they used a pandemic virus, a decision Stohr described as "unwise," and "unfortunate." That's the thing about a blog. Klaus Stohr has to say "unwise" and "unfortunate." Revere can say, "major fuck-up."

WHO is urgently calling on the labs to destroy the virus immediately and verify it has been destroyed within 24 hours. But even if these vials are destroyed, others probably exist:
Stohr said the test kits are not the only supplies of the 1957 pandemic strain sitting in laboratories around the world.

"The world really has to think what routine labs should be doing with these samples they have kept in the back of their fridges," Storh said.
With friends like these, who needs bioterrorists?

[NB this post has been amended slightly from the original.]

Update (4/13/05, 9:30 am EDST): Reuters reports this morning that some of the laboratories that received the proficiency kits outside of the US and Canada included Saudi Arabia, Jamaica, Mexico, Lebanon, Brazil, Hong Kong and Italy. WHO's Stohr is saying that these labs would have had the "approval of their governments." I doubt this could mean "specific" approval. It may merely mean government certification of the laboratory to handle specimens. Stohr says that laboratories in Canada, South Korea, Hong Kong and Singapore have already reported they destroyed the virus. He also notes that not all of the US laboratories have been identified.

Update (4/13/05, 4 pm EDST): Here is the complete list of countries that received the kits, courtesy of DemFromCT (and his excellent site that also tracks bird flu The Next Hurrah):

Bermuda, Belgium, Brazil , Chile, France, Germany, Hong Kong Special Administrative Region of China, Israel, Italy, Japan, Lebanon, Mexico, The Republic of Korea, Saudi Arabia, Singapore, Taiwan, China

WHO also has this to say:
As of today, there have been no reports of H2N2 infections in laboratory workers associated with the distribution of the H2N2 samples from CAP. The proper use of biological safety cabinets, along with the use of recommended personal protective equipment, greatly reduces the risk of laboratory-acquired influenza infections. While a few H2N2 laboratory acquired infections have been documented in the past, the likelihood of laboratory-acquired influenza infection is considered low when proper biosafety precautions are followed.
The obvious question: what about when proper precautions are not followed?

Source: International response to the distribution of a H2N2 influenza virus for laboratory testing: Risk considered low for laboratory workers and the public

What's going on in Ho Chi Minh City?

It is hard to know what to make of the report out of Ho Chi Minh City (neé Saigon) that thousands of children are filling two pediatric hospitals with respiratory and digestive illnesses "due to hot weather." The implication is that heat or its attendant dehydration are responsible. Abnormal respiration is seen frequently in dehydrated children but it is usually rapid and deep and not usually described as a "respiratory illness." Thus much hangs on the meaning of "respiratory problems" in this case. There seems to be no other source of information beyond the story in Tranh Nien (the same daily that broke the story about 195 with flu-like illness in Quang Binh, where we still await follow-up information).

The hot season seems wrong for Respiratory Syncytial Virus, a frequent cause of lower respiratory infection in infants and upper respiratory infections and bronchiolitis in older children. The next most common cause would be one of the parainfluenza viruses, but again, the hottest months don't seem right for this (usually winter-spring or fall events). Influenza A and B would also seem to be in the differential here, and if it is influenza A, one would have to worry about H5N1.

Niman at Recombinomics has made a note of this event, and rightly so. From this vantage point the possibilities range from minimal risk to extremely serious. We hope authorities will clarify soon. As always, Hope Springs Eternal.

. . . and take your kids to the seashore

Americans work harder and take fewer vacations than people in almost any other modern industrialized nation--except, of course, if you are unemployed. Then you are on a more or less extended vacation, but not the kind you'd like.

The Head of Social Welfare in Zagreb City Council has come up with a novel solution to this problem. Croatia's capital has 41,000 people out of work in a population of 1 million. Councillor Zvonimir Sostar is proposing that the unemployed be put to work, but instead of being paid in money wages they will get holidays in luxury spa resorts.

What a great idea. But as with all innovative ideas, some traditionalists resist change:
City councillor Tomislav Jelic, said: "Unemployed people need jobs to earn money for their families. They do not need holidays at a spa." (via Ananova)
Hey, c'mon. Everybody needs a holiday at a spa.

If there's a ring, there must be a finger in there somewhere

This is a companion story to our previous post about the woman who found a human finger in her Wendy's chili.
A man from Kent claims he found a £12,000 ring in some cooking sauce.

Kevin Luetchford says he was cooking a meal for his girlfriend with Chicken Tonight sauce when he came across the ring reports The Sun. (via Ananova)
Maybe just the ring dropped into the cooking sauce. Maybe not. I wonder if the sauce was the "chunky" kind.

Monday, April 11, 2005

Lakoff - XVII: reference frames versus framing

Coturnix, in an extremely interesting post on the current discussion of Lakoff, makes the point that there is a difference between systems of government and (what he calls) "personality traits" (by which I take him to mean the preference for one or another hierarchy of moral values, in Lakoff's sense). He also implies another (unintended) distinction: political science (the study of systems of government) versus "the psychology of ideology" (which explains why he calls this "personality traits").

What makes this particularly interesting is that I often think of the distinction between clinical medicine and public health as related to whether the object of study is the individual (clinical medicine) or the population (public health, particularly epidemiology). For me there is an isomorphism here between the pair, clinical medicine/public health and the pair psychology/sociology, the latter also two complementary but different ways of looking at people (singular and plural). Note that we also have political science or government, referring to particular social structures, and anthropology, the study of human culture and cultural roles, germane to the question of where "family" and gender roles fit in, issues that Lindsay and Ezra Klein raise. So some of the confusions that seem to be swirling around how to treat the Lakoff issue may be related to the disciplinary frame of reference/vocabulary we use (i.e., the disciplinary frame of reference about Lakoffian frames).

Coturnix is probably closer to Lakoff himself in using psychology as a reference point. Lakoff's work is quite psychologistic (pardon the ugly neologism), which might account for some of the difficulties when it is applied to settings where political science or sociology seem relevant (voting patterns, systems of government) or where anthropology intrudes (gender roles, family structure). Coturnix is also correct that Lakoff conceives of Strict Father and Nurturant Parent as psychological prototypes or ideal types (the center of radial categories), not types of people. As I pointed out in an earlier post, most of us are complicated mixtures of these two ideal types. Their use by Lakoff and Coturnix refer to some kind of average or central tendency that a person might exhibit (Coturnix's "personality trait").

Coturnix further asserts these personality traits do not determine ideologies. This is a more complicated question related to how psychology determines ideology or vice versa. This is pretty deep water and different disciplines approach it differently. It also suggests that cookie-cutter Lakoffianism is pretty naive and that maybe Lakoff himself is naive about some of this. But whether the latter is true or not, it doesn't mean we have to reject some of the extremely valuable insights Lakoff has produced in the course of his work in cognitive linguistics, particularly the unrecognized (by progressives) role of unconscious metaphor in making political inferences. It does mean that we have a lot of tough theoretical labor before us, labor I believe the Left has been too lazy to perform. We have subsisted on slogans, slogans that don't even work for us anymore.

Coturnix also has an extremely interesting list of differences in Conservative and Liberal ideologies which he presents without argument, inviting us to peruse his site for past posts on the subject. Here is a request: can you set out an index of links to allow us to do this? Some of the entries seem quite plausible while others (e.g., concepts of "time" which is one of Coturnix's special interests) are opaque to me.

Coturnix ends with the "parable of the public park" which seems completely wrong. In his parable, the Conservative architect designs a public park in a top down fashion and then wonders why people don't use it as anticipated while the Liberal waits to see what people want and achieves acclaim. But the real world is often just the opposite. The Conservative does market research and designs things according to the results, while Liberals design things according to desirable principles that are then subverted by forces that prevent their operation.

Let me advance an alternative view. Lakoff's method has identified a number of primary metaphors he believes are nearly universal across cultures. They have a basis in behaviors that have evolved to respond to common situations in a way that optimize species survival and are embodied in neural structures. Some of these behaviors are more compatible with Conservative tendencies (the value of reward and punishment, obedience to authority) and others with Liberal ones (the value of nurturing, the importance of cooperation and altruism). How these are balanced in terms of species survivability will depend on historical contingencies. I believe it is "Liberal" belief that at this stage in human history the balance must tip in favor of Liberal behaviors and values or the species will not survive. This is argued in moral terms but is at root a question of empirical fact that history will decide. Whether we will be around to appreciate the answer is the question at issue.

If this is correct, the "framing" question involves finding language that activates these Liberal-oriented primary and complex metaphors. I have earlier suggested phrases like "We are all in this together" and "None of us are safe until we are all safe" as candidates for expressing the public health realities of responding to the threat of an influenza pandemic in a "liberal" way. I am sure there are many other or better examples if we put our minds to it.

This is an extremely important discussion and I worry that the Lakoff business will be facilely dismissed on superficial grounds (for example, that Lakoff himself is a bad "framer" or that "framing" is just spin). If that happens, we will be missing an important opportunity and slide back into a lazy intellectual position: that we understand things sufficiently.

We don't. Look around you.

Death information and information dearth

The death of an 8 year old little girl from bird flu in Cambodia (AP) brings the official count there to 3 in the latest outbreak, but as Niman at Recombinomics reminds us, the actual count should be 4 since the index case of case number 1 isn't being counted. All cases ended fatally and all were in Kampot province, adjacent to the Vietnam's Mekong Delta region. At this time there is no information on exposure history.

But that's not the only thing there isn't any information on. Niman also reminds us that several important issues are still unresolved, including the outcome of the 195 cases of flu-like illness in Quang Binh province, the investigation into the cause of death of the doctor in Quang Ninh and the testing results on the hospitalized neighbors of the Haiphong family of five with H5N1.

If authorities (both Vietnamese and WHO) don't know the answers to these questions yet they should tell us so and why. If they do, well, . . .

Let me say it another way: How stupid can you get?

Sunday, April 10, 2005

Summit cum laude

April 9, 2005 may turn out to be a significant day, the day a progressive student public health movement began again.

That was the day public health students from around the northeast met at Boston University School of Public Health for the first Student Summit on Defining the Future of Public Health. That it happened at all is significant. That it turned out so well is even more significant. The fake true Revere was there and here's what Revere saw.

The seventy-odd attendees were treated to a spectacular start with a keynote by Judith Kurland, president-elect of the Massachusetts Public Health Association, former Commissioner of Health for the City of Boston, former Region I DHHS Director. Despite these establishment credits, Kurland could be described more as a leftist than a liberal. Her talk was about fashion, horror movies and magicians, namely, the stunning economic inequality in our society that purveys "essential wardrobes" costing $1100 in the New York Times Fashion supplement but simultaneously won't allocate $50 clothing allowances for children on AFDC ("too generous"); replays in real life old horror movie themes wherein a hero or heroine trying to warn of mortal danger is called a nut by the authorities ("global warming"); and where distraction and sleight of hand are used to mystify the public ("war on terrorism").

There followed simultaneous workshops on topics such as "The legacy of health activism," "War and public health," "Public health advocacy," "The US and global public health policy," "Biodefense, bioterrorism and local public health." The current generation was joined by activists of an earlier one, among them: Peter Montague (Rachel's Environmental Newsletter, one of the great heroes of the environmental movement); Dick Clapp, Dave Ozonoff, Tom Webster (now all in the Department of Environmental Health at the BU School of Public Health). Time was set aside for attendees to organize into special interest caucuses so students with particular interests could network. And all came together at the end of the day for a short plenary and a terrific catered Tanzanian dinner at the Community Church of Boston (one of the venerable "movement" churches in the area).

This was a significant event, carried off beautifully by a new generation of public health activists at the BU School of Public Health, to whom kudos are due. Similar events will follow at other schools in other areas, judging from plans and comments we overheard. Let's hope so.

To give a bit of the flavor, here is a small excerpt from the closing remarks:
It is time to rebuild a progressive public health movement. The fact that a handful of students here, students with little organizing experience, few models to show the way or resources to work with, could summon, on short notice, colleagues from all over the northeast says something about a desire and energy that is reasserting itself.

If there is any silver lining to the past election it is that the lines have become more clearly drawn and the stakes more starkly illuminated, stakes as high as have ever been played. Not getting in the game is no longer an option. For many it will be the adventure of a lifetime, something that defines our life and gives it purpose and meaning.

We are part of a long tradition of fighting for social justice and a better world. It began long before we were born and will doubtless go on long after we are dead. We are Links in the Chain.
But what a wonderful chain!