Saturday, December 31, 2005

Aulde lang flush

Last day of the year, 2005. Not a wonderful year for me personally and the world didn't fare much better (which will give you an idea of how bad my year was. So I'll be glad to flush 2005 down the old crapper. But how will I know it will really go down? Answer: miso, soy bean product and vegan mainstay.

I'm not big fan of miso, but I've discovered there is one thing it is definitely good for: testing the efficiency of a flush toilet. About that shortly, but speaking of Dick Cheney, how do toilets flush, anyway?

Most people don't know. I'm guessing they have some kind of vague mental image that when you push the toilet handle a trapdoor opens up somewhere and the contents of the toilet bowl fall through to the abyss. But that's not what happens.

Most household toilets work using a bowl siphon. Yes, a siphon, just like you will be doing during the next gas crisis when you steal gas from your neighbor's car. You remember how you did that the last time, right? You put a tube into the gas tank and sucked some gas into it until the gas "went over the top of the bend" and, assuming the other end of the tube outside the car was lower than the level of the end in the gas tank, the siphon would empty out the gas in your neighbor's car into your gas can and you were on the road again (and also assuming you didn't suck the gas all the way into your mouth and wind up aspirating it and get an ensuing hydrocarbon pneumonitis).

So now we have three questions: (1) What makes a siphon work, anyway? (2) What does that have to do with flushing a toilet? (3) What does this have to do with miso?

(1) A siphon works by exploiting the difference in the weight of the water in the two columns. Here's a good way to visualize it. Suppose you have a length of chain, with an excess in a beaker and the rest running smoothly up over a pulley and back down to the table top. How take the beaker in your hand and raise it. You'll find that the chain "runs out" of the beaker, over the pulley and down to the table on the other side. That's because the length of chain on the other side of the pulley is longer when you raise the beaker on the near side up, and the longer chain is heavier and pulls chain from the "lighter" (higher) side. Here is a good set of pictures of the set up.

(2) So where is the siphon in a toilet?

You can see from this picture there is a siphon in back of the bowl. When you push the toilet handle down, water from the tank in back of the toilet (not shown in this picture) starts to fill the toilet bowl more quickly than the water can flow over the siphon bend, and water, seeking its own level both in the siphon tube and the bowl, completes the siphon and the bowl empties. In fact it empties more quickly than the water runs into it from the tank, which is sized just right so that it refills the bowl again after it empties. The amount of water running into the bowl is sized so that when it is finished running the level is below that needed to complete the siphon. The valve from the tank now closes and water from your plumbing connection refills the tank and you are ready to "go" again. This explains how you can flush a toilet just by filling it from a bucket of water instead of the tank (you didn't know that? try it at home). There's a nice animation here.

(3) Back to miso.
For decades, the toilet industry had a standard way of testing a toilet's flushing capabilities: tossing 3/4-inch plastic balls into the bowl and pulling the handle. But there was one problem: Toilets that are fantastic at flushing down 3/4-inch plastic balls sometimes falter under real-world conditions.

A few years ago, researchers began pondering a better test. After scouring grocery aisles for alternatives, they settled on using miso, which is made primarily of cooked soybeans.

Now, a group of water utilities and plumbing companies is pushing to make the miso test the new standard. This month, the group, which includes Kohler Co. and American Standard Cos., is rolling out a set of rules called UNAR -- that is Uniform North American Requirements for toilet fixtures -- which lay out a flushing standard that toilets have to meet. A key element of the suggested rules, which also include standards for toilet parts, is the use of a miso paste in testing.


Since 1978, toilet makers had been using the plastic-ball test, which involved dropping 100 balls into the toilet; the toilet had to dispose of at least 75 in one flush to pass. (Cheryl Lu-Lien Tam, The Wall Street Journal)
The article is long, and for some, "too much information," so suffice it to say the test involves fashioning miso paste into a cylinder to test flushing efficiency. The UNAR standard is meant to be like the "Energy Compliant STAR standard" for electrical appliances. In the 1950s we used 5 - 7 gallons to flush a toilet (toilet flushing is the largest use of water in the home--by far). That was lowered to 3.5 gallons subsequently, and in 1992 the Energy Policy Act required all new toilets to use only 1.6 gallons per flush. This ushered in the era of the skidmark and the dreaded double-flush. Now, with better designs, low volume toilets are finally getting it together. But manufacturers, and likely regulators, will want a good test for flushing efficiency. UNAR's miso test stands (floats?) poised to become that standard.

One more thing. Miso is the efficiency tester that "dares not speak its name":
Most manufacturers are careful to call the substance "soybean media" at the request of the miso merchants who sell the product. (The miso companies also insist that toilet makers not mention their names in connection with their testing.)
I guess they don't want to be identified with siphons, used to steal other people's gasoline.

Back to the New Year's "business." Let's make 2006 the year we flush the friends of George, Dick, Rummy, Condi and the rest of that pile of crap clogging up our democracy. It'll take a double flush to get rid of the really big ones. 2008.

Friday, December 30, 2005

Chicken fingers pointing

A couple of days ago BirdLife International suggested avian influenza might be spread by using poultry manure as food in fish farms, something done routinely in Asia.
Known as integrated livestock-fish farming, the technique involves transferring the wastes from raising pigs, ducks or chickens directly to fish farms. At the right dosage, the nutrients in the manure give an enormous boost to the growth of plankton in the ponds, which are the main food of fish such as carp and tilapia.

BirdLife International is now calling for an investigation into the possibility that thousands of manure-fed ponds across Asia may be the means by which the new potentially deadly strain of avian influenza, H5N1, is being spread. BirdLife points out that outbreaks of H5N1 have occurred this year at locations in China, Romania and Croatia where there are fish farms. (The Independent)
This is a pretty interesting story, with intrigue and not very hidden agendas all over the place. The bird conservation community has been seriously exercised over the claim by WHO and the UN Food and Agriculture Organization (FAO) that wild migratory birds are vectors of bird flu, especially the H5N1 subtype. They fear (with some justification) that governments and localities will rashly carry out massacres of wild birds and try to deny them natural habitat. Even if these birds do carry the virus (and in our view it is likely they do), there is little anyone can do about it. You can't kill all wild birds nor would you want to. You could do a lot of environmental damage trying, however. So birders and ornithologists have been waging a full scale counter-attack on the notion, a counter-attack that often includes blanket denials that wild birds can be carriers.

The FAO, on the other hand, has been actively promoting integrated livestock-fish farming as a means to provide lower cost protein to the developing world. Another worthy idea. But the idea that virus contaminated poultry feces might be a source of contamination for wild birds and others makes both scientific and commonsense:
Although no mention has been made of the possible links between manure-fed ponds and influenza in the recent alarm over bird flu, the issue has been raised before, and the FAO, although actively promoting the technique, is well aware of the threat.

Its 2003 report, Integrated Livestock Fish Farming Systems, noted: "Recently, livestock and fish have been implicated in the irregular occurrence of influenza pandemics; the global impacts on public health of promoting livestock and fish integration are huge if these claims are substantiated."

In fact, the FAO may have been aware for very much longer that some scientists think there is a risk. The 2003 report includes a reference to a paper published in the journal Nature in 1988. This paper, by Christoph Scholtissek from the University of Giessen in Germany and Ernest Naylor from the University of Bangor in Wales, was titled Fish Farming and Influenza Pandemics. It said that bringing together fish farms with farm livestock "may well be the creation of a considerable human health hazard".

However, the FAO has continued to promoted integrated livestock fish farming actively throughout the ensuing period. (The Independent)
Now FAO is shooting back. Sort of. If you call being arrogantly dismissive, "shooting back." Their Chief Veterinary officer, Dr. Joseph Domenach told Reuters it was a "theoretical risk" but would only be a local problem for birds that used the contaminated pond. Adequate surveillance would take care of the problem, he said. As for wild birds:
"Today it's impossible to say that wild birds are not playing a role," said Domenech. "We hope in three to four months, at the end of this migration period, we will see better."
Of course what if they are both right: infected poultry feces are contaminating ponds where migratory birds drink and then spread it elsewhere. I don't think either side would be satisfied with that compromise because each blames the other as a means to protect its own concerns.

Ask Not for whom the Chicken Fingers point. They point for Thee.

Mileage-based car insurance?

I don't drive that much and it is mostly city driving. If my community had decent public transport to my job I'd probably take that. But I know people who drive a lot, commuting one to two hours a day to work and the same back. They are at greater risk for an accident than I am because they are on the road more. But they usually pay less car insurance because their cars don't get stolen as often. They deserve the break in theft insurance because their risk is less. Why don't I get a similar break on accident insurance because I drive less?

A Japanese insurance company is now offering car insurance keyed to miles driven, determined by a device in the policy holder's car:
Pay-as-you-drive insurance (or PAYD) offers huge advantages over the all-you-can-drive policies that dominate the U.S. First of all, PAYD is fairer, since it doesn't force low-mileage drivers to subsidize people who drive a lot. Generally speaking, crash risk accrues by the mile: People who drive more crash more. But most insurance policies don't sufficiently account for the differences in risk -- meaning that low-mileage drivers overpay for insurance, while high-mileage drivers underpay. Even the policies that give a price break to relatively low-mileage drivers don't close the gap: People who don't drive much still get shafted.

Not only is pay-by-the-mile insurance fairer to low-mileage drivers, it also creates an automatic disincentive for extra driving: Just as an all-you-can-eat buffet makes it more likely that you'll gorge yourself, all-you-can-drive insurance policies make it likely that you'll drive more. Because most people pay more for their car insurance than for gas, PAYD has roughly the same effect on driving as a doubling in the price of gas.(via Gristmill)
Of course I don't live in Japan. But Gristmill now tells me that California is contemplating a similar scheme. And there is an Environmental Justice bonus as well. Minorities who live in urban neighborhoods won't be paying higher rates for accident insurance than suburban drivers with similar records. As Gristmill points out, this isn't a reality yet:
Obviously, this is not yet a done deal. But it's still promising -- because it could make the automotive insurance system fairer to people who don't drive much (notably women, the poor, and city-dwellers), and because it could give all drivers the opportunity to control their insurance costs by driving less.
Sounds like the only ones who don't win on this one are the oil companies. It's a good thing they don't have much influence with the government.

Thursday, December 29, 2005

Charlie the Tuna and states rights

Congress has come up with a fix for a daunting problem: the worry that comes from consumers, especially pregnant women, about whether the food they eat will harm their unborn babies. It turns out the solution is incredibly easy: eliminate the warnings. Brilliant, as usual.

Here's how it's supposed to work, according to legislation approved by the House Energy and Commerce Committee shortly before Congress adjourned for the Christmas recess. All 50 states have laws that require point of purchase food safety notices of one kind or another. Under the bill introduced by Republican Mike Rogers of Michigan and co-sponsored by 200 of his closest friends and accomplices (with the encouragement of numerous lobbyists), some 80 laws in 37 states would be eliminated, pre-empted by Federal authority. That will improve interstate commerce by eliminating the confusion of separate food safety warnings in the different states. You have to admire the flexibility and pragmatic attitude of "states rights" Republicans. They aren't bound by principle.

Of course there is a little more to it. Like tuna. Because in fact the main target is California's attempt to put strong warnings on tuna because of mercury contamination. Mercury is a known neurotoxin, and a series of landmark studies conducted in the Faroe Islands by Philippe Grandjean and his colleagues has shown that levels of mercury commonly encountered by consumers may have effects on fetal development.

California is being sued by the Tuna Foundation and their suit was joined by the FDA. And you thought the FDA was on the side of consumers? Silly you. Did you forget about Vioxx? At issue is the belief by independent scientists, the American Public Health Association and the American Medical Association that the current FDA mercury advisory is not protective and would allow exposures of an estimated 600,000 fetuses above current EPA reference levels.

Attempts by Democrats to postpone or modify the gutting of state control over food warnings were to no avail. Representative Lois Capps, a Democrat representing Santa Barbara in southern California tried to exempt state laws dealing with birth defect warnings but was defeated 32 - 31. California Democrat Henry Waxman's amendment to permit states to help parents limit their children's exposure to cancer-causing agents or developmental toxins was also defeated, 26 - 19.

But did you expect anything else from the Republican controlled congress? Sorry, Charlie.

Hospitals, churches but no wiretaps, just death

If irony isn't dead in the Bush administration is in a Persistent Vegetative State, so one isn't surprised to find the following defense of Bush's wiretapping of American citizens:
"This is not about monitoring phone calls designed to arrange Little League practice or what to bring to a potluck dinner," he told reporters. "These are designed to monitor calls from very bad people to very bad people who have a history of blowing up commuter trains, weddings, and churches."(Reuters via AmericaBlog)
I am certain those aren't the American citizens being wiretapped. Blowing up weddings and churches [do mosques count?]" by US citizens does occur, of course. We do it from the air:
Despite widespread Iraqi casualties, household interview data do not show evidence of widespread wrongdoing on the part of individual soldiers on the ground. To the contrary, only three of 61 incidents (5%) involved coalition soldiers (all reported to be American. . . ) killing Iraqis with small arms fire. . . The remaining 58 killings (all attributed to US forces by interviewees) were caused by helicopter gunships, rockets, or other forms of aerial weaponry. (my emphasis) (post in Effect Measure)
WaPo makes the same point:
U.S. Marine airstrikes targeting insurgents sheltering in Iraqi residential neighborhoods are killing civilians as well as guerrillas along the Euphrates River in far western Iraq, according to Iraqi townspeople and officials and the U.S. military.

Just how many civilians have been killed is strongly disputed by the Marines and, some critics say, too little investigated. But townspeople, tribal leaders, medical workers and accounts from witnesses at the sites of clashes, at hospitals and at graveyards indicated that scores of noncombatants were killed last month in fighting, including airstrikes, in the opening stages of a 17-day U.S.-Iraqi offensive in Anbar province. (Washington Post)
Friday, October 8, 2004 Posted: 1:02 PM EDT (1702 GMT) An airstrike killed 14 people and wounded 16 during a wedding party, according to hospital officials in the unstable city of Falluja, but the U.S. military said its planes had targeted a terrorist safe house.

An emergency room doctor said the strike killed the groom and wounded several women and children.

The U.S.-led coalition statement had reported an airstrike at 1:15 a.m. on a safe house in northwest Falluja where terrorist leaders linked to Abu Musab al-Zarqawi were meeting.

People are still searching for bodies underneath the rubble of the house, neighbors told a CNN journalist in the city.

The city's hospital said it received the dead and wounded from the wedding party around 2 a.m. (6 p.m. ET). (CNN)
Or this:
BAGHDAD, May 24 (Reuters) - New video footage showing Iraqis singing and dancing at a desert wedding raised more questions on Monday about a U.S. air strike last week that killed about 40 people.

The U.S. military insisted most of the dead were foreign guerrilla fighters who had slipped over the nearby Syrian border. Local people say the Americans massacred wedding guests.

"We still don't believe that there was a wedding or a wedding party going on when we hit in the early hours of the morning," a senior military official said, adding that daylight scenes on film might be of a wedding held there the day before.

Associated Press Television News said it obtained the footage from a survivor of the strike early on May 19.

The U.S. military says troops found no signs of a wedding in the wreckage left at the remote hamlet of Mogr al-Deeb. But a spokesman, Brigadier General Mark Kimmitt, conceded on Saturday that six women were killed in the strike and a celebration may have been taking place: "Bad people have parties too," he said. (Iraq Today)
Coalition forces fired upon a mosque compound in Fallujah that officials said was a safe haven for enemy fighters on Wednesday as U.S. Marines continued their advance into northern areas of the city.

Marines waged a six-hour battle around the mosque with militants holed up inside before a Cobra helicopter fired a Hellfire missile at the base of its minaret and an F-16 dropped a bomb, said Marine Lt. Col. Brennan Byrne.

There is no report of civilian casualties, the military said, disputing earlier witness accounts that as many as 40 people died. (FoxNews)
Commuter trains? OK. We have no reports of US military forces bombing commuter trains.

But the weddings, mosques and trains aren't really the point. The deadliness of aerial bombardment is. As everyone familiar with anti-insurgency warfare knows, civilian deaths are inevitable when bombs are loosed through the air. It is as sure as the civilian casualties that come when insurgents attack police stations or symbols of the US occupation, like hotels. The insurgents may not be aiming for civilians but they know they will hit and kill innocent people. So does the US military. No matter how much they may "regret" the loss of innocent life, to them it is necessary but unfortunate collateral damage. As it no doubt is to the insurgents.

Here is the problem in all its terrible ambiguity:
The number of airstrikes carried out each month by U.S. aircraft rose almost fivefold this year, from roughly 25 in January to 120 in November, according to a tally provided by the military. Accounts by residents, officials and witnesses in Anbar and the Marines themselves make clear that Iraqi civilians are frequently caught in the attacks.

On Nov. 7, the third day of the offensive, witnesses watched from the roof of a public building in Husaybah as U.S. warplanes struck homes in the town's Kamaliyat neighborhood. After fires ignited by the fighting had died down, witnesses observed residents removing the bodies of what neighbors said was a family -- mother, father, 14-year-old girl, 11-year-old boy and 5-year-old boy -- from the rubble of one house.

Survivors said insurgents had been firing mortars from yards in the neighborhood just before the airstrikes. Residents pleaded with the guerrillas to leave for fear of drawing attacks on the families, they said, but were told by the fighters that they had no other space from which to attack.

Near the town of Qaim one day last month, a man who identified himself only as Abdul Aziz said a separate U.S. airstrike killed his grown daughter, Aesha. Four armed men were also found in the rubble of her house, he said.

"I don't blame the Americans. I blame Zarqawi and his group, who were using my daughter's house as a shelter," said Abdul Aziz, referring to Abu Musab Zarqawi, leader of the foreign-dominated group al Qaeda in Iraq.

Abdul Aziz spoke beside his daughter's newly dug grave, in a cemetery established for the 80 to 90 civilians who Anbar officials said were killed in the first weeks of the offensive. Several dozen new graves were evident, and residents said more than 40 victims of the fighting were to be buried that day alone. Witnesses saw only 11, all wrapped in blankets for burial. Residents said two of the 11 were women.

Abdul Aziz's grandsons ascribed blame for their mother's death more pointedly. "She was killed in the bombing by the Americans," said Ali, 9, the oldest of three brothers. (WaPo)
That last sentence, however one ascribes blame or motive, is the bare truth: "She was killed in the bombing by the Americans." Predictable in every sense of the word. As predictable as the loss of innocent life in an insurgent attack in a crowded city. But on a bigger scale and even more impersonal. And if the reason is oil or geopolitics (as many of us believe), how morally defensible?

Obviously a rhetorical question.

Wednesday, December 28, 2005

Role of migratory wild birds and what to do about it (if anything)

The problem of H5N1 virus traveling the globe via migratory birds has been, shall we say, contentious. Because migratory birds have a constituency--birders and ornithologists. Which is a good thing for the birds and ultimately a good thing for flu science. Ultimately. I think the evidence implicating movement of the virus via migratory wild birds is fairly good, maybe even compelling. But I would have to agree there are many major uncertainties as well.

The principal argument of the bird community seems to be that birds sick with avian influenza cannot fly far. But there is also good evidence that the virus is highly pathogenic for some bird species and not others. So this argument isn't persuasive. The argument that if they are truly a source of infection we should see outbreaks throughout their migration paths seems more plausible, but surveillance is not that good in many of these areas, nor do we know the spatial patterns of viral shedding. The fact that outbreaks have occurred where there is no evidence of migratory birds means that either we haven't detected the presence of those birds, or more likely, that there are other ways of spreading the disease, of which spread via wild birds is only one, but an important one for geographic dispersion.

But it is true that there is much to learn, and taking precipitous action in the face of this kind of uncertainty may do more harm--perhaps much more harm--than good. Culling of wild birds or destruction of their natural habitat, as has sometimes been suggested, is neither feasible nor likely to succeed, even if it could be done. What it would almost certainly do, however, is contribute further to the already alarming deterioration of our environment and its biodiversity.

If migratory birds are indeed spreading the virus, as seems likely in some instances, there is not much we can do about it except recognize the importance of surveillance along the migratory pathways and get ready for the consequences. Reform of industrial poultry raising practices and control of indiscriminate spreading of poultry manure also seem like sensible things.

I don't think that wild birds are innocent of spreading this virus and I think denying this is not productive. What we need is some clear thinking about what can and should be done about migratory birds--if anything. It is possible--and I think likely--that this is a variable we cannot control and attempts to do so will turn out to be harmful.

Bird flu and peace in the Middle East?

Could one of the species of wild migratory birds carrying bird flu be a white dove of peace? Dr. Alex Leventhal, the Director of Public Health Services in the Israeli Ministry of Health thinks there's a chance, and I hope he's right:
"We don't know when, but it is predictable," he says. "The migratory birds pass over Israel, Palestine and Jordan twice a year. We are speaking about more than five hundred million birds of which some may be carriers of the virus. This scenario, which we are afraid of, is possible. This is what occurred in Romania, Turkey and Croatia," explained Leventhal.

Dr. Leventhal is challenged by several difficult elements in his daily battle preparing for avian flu. "The problem is that the migratory birds descend for less than one day and fly away again. They may come in contact with poultry and perhaps transmit the virus to them. The disease in poultry is contagious and fatal to the husbandry" warned Leventhal. (ynetnews)
An avian influenza epidemic amongst poultry would be an economic disaster for the region, not Israel alone. And a pandemic would be as serious here as everywhere else and require international cooperation and coordination and mutual aid.
"We are working together with the Palestinians and the Jordanians. We met with the Jordanians on the King Hussein Bridge. Also, there was a meeting with Palestinian officials from the Ministry of Health including the veterinary services in Beit El in Ramallah. The Jordanians suggested a tripartite meeting which we will organize within a week," Leventhal said.

"We decided the Israelis, the Jordanians and the Palestinians should share strategic plans and try to work in conjunction. We have good cooperation with the Palestinian Authority. There are excellent professionals like Dr. Asa'd Ramlawi and Dr. al-Masri.

We told them that we are ready to help them to be able to handle their situation. My teacher taught me an Arabic proverb, ‘A close neighbor is better than a distant brother.’ I hope to see other countries like Lebanon, Syria, and Egypt working with us as well."
The world has only had a "national system" (i.e., been organized into nation states) for about 400 years. The threat of epidemic infectious disease shows that system has severe limitations. How the hard won nationalist aspirations of Palestinians and Israelis will cope with this is uncertain, but overwhelming outside events often force arrangements not conceivable in other ways. Nationalism has been a major vehicle for political advance and the liberation of peoples from colonial yokes. But it is also a tribalism with baneful consequences.

Israelis and Palestinians are both close friends and not-so-distant brothers and sisters. If the threat of an avian flu pandemic weakens these regional nationalisms at this juncture, so much the better as far as I am concerned. An effort by Israeli and Palestinian public health professionals to build bridges is a good step. Take a look at their magazine, bridges.

Tuesday, December 27, 2005

The whole truth

In sworn testimony in an employment lawsuit Dr. Edmund Tramont, head of AIDS research at the National Institute for Allergy and Infectious Diseases (NIAID/NIH) did what he was supposed to do: told the truth about Big Pharma and the AIDS vaccine.
In an unusually candid admission, the federal chief of AIDS research says he believes drug companies don't have an incentive to create a vaccine for the HIV and are likely to wait to profit from it after the government develops one.

And that means the government has had to spend more time focusing on the processes that drug companies ordinarily follow in developing new medicines and bringing them to market.

"We had to spend some time and energy paying attention to those aspects of development because the private side isn't picking it up," Dr. Edmund Tramont testified in a deposition in a recent employment lawsuit obtained by The Associated Press.


"If we look at the vaccine, HIV vaccine, we're going to have an HIV vaccine. It's not going to be made by a company," Tramont said. "They're dropping out like flies because there's no real incentive for them to do it. We have to do it."

"They will eventually — if it works, they won't have to make that big investment. And they can make it and sell it and make a profit," he said. (AP via Canadian TV)
As Tramont acknowledged in a follow-up email to the AP, this isn't just a problem for the AIDS vaccine, but vaccines in general. The countries that are most in need cannot afford to pay enough to result in the obscenely high profits drug companies can make selling impotence drugs or psychoactive agents that are taken on an ongoing basis, so they wait for taxpayers to pick up the research and development costs and if it suits them, they move in later to scarf up the profits.

The Republican congress, led by Senator Bill ("Dr. Quackenbush") Frist has come up with a perfect solution. Indemnify or immunize the pharmaceutical industry prospectively against lawsuits (using the need for incentives) while letting them profit from the publicly sponsored research as before.

We've said it before and we'll say it again: if the "market" doesn't work, don't interfere with the market by forcing it (see here and here). As with other matters of national defense, produce the vaccines with public funds or under the usual contract mechanism instead of letting Big Pharma gain exclusive rights via licensing and patents to which they are not entitled.

Monday, December 26, 2005

Happy New (flu) Year

If you live in the southwest of hte United States you have probably noticed that seasonal influenza is here:
During week 50 (December 11 – December 17, 2005)*, influenza activity continued to increase mostly in the southwestern United States. One hundred sixty-nine (8.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza. The proportion of patient visits to sentinel providers for influenza-like illness (ILI) was above the national baseline. The proportion of deaths attributed to pneumonia and influenza was below the baseline level. One state reported widespread influenza activity; 5 states reported regional influenza activity; 2 states reported local influenza activity; 33 states, New York City and the District of Columbia reported sporadic influenza activity; and 9 states reported no influenza activity. (CDC)
In Maricopa County (Arizona) some Emergency Rooms have wait times as long as 12 hours. Over 80% of the year's flu cases has come in the last two weeks (station KOLD via East Valley Tribune/Scottsdale Tribune). In El Paso, Texas the situation is similar:
The flu season is in full swing, as Luis Calvo, who has the flu noticed while he waited in the packed waiting room at the at the Franklin Medical Clinic for hours to see a doctor.

Doctor Andres Enriquez at the Franklin Medical Clinic says his waiting room was so packed that for most of the day there was standing room only and some people actually had to wait outside of the building.

According to Dr. Enriquez 90 percent of the patients he saw on Christmas Eve had the flu like Luis.
And it is not just Dr Enriquez that is seeing more patients. In fact 24 hour pharmacies like Walgreen's saw longer lines this holiday weekend.

"We have seen an exceptional increase in people with various respiratory complaints the reason why we know it appears to be a flu problem is because there has been an increase of people with prescriptions for Tami-flu," says Allen Hrich, a Walgreen's Pharmacist.

But, flu patients not only lined-up to get Tami-flu, they are also looked for other drugs like Suda-fed which you used to be able to get off the shelf, but because of the meth problem you now have to get it from a pharmacist. (KFOX-TV)
The interaction with the substance abuse problem (Sudafed being made into meth) and the stress on the medical care delivery system with even a mild uptick in flu cases shows once again how the public health and social services infrastructures areinterconnected in ways that don't allow us to "target" discrete areas (like antiviral stockpiling or vaccine production and distribution) as ways to respond to an influenza pandemic. Unfortunately we cannot except consumer protection from that list, either:
It was the kind of event companies hold all the time. ExxonMobil had a health fair for its refinery workers in Baytown, Texas, and offered free flu shots. Only the people hired to administer the shots were not qualified health-care professionals and the vaccines they gave were purified water.


This year in Texas, U.S. Atty. Chuck Rosenberg said a Houston businessman, Iyad Abu El Hawa, and his alleged accomplice, Martha Denise Gonzales, were indicted on charges of giving fake flu shots. The two suspects were charged last month with conspiracy and tampering with consumer products; they had allegedly inoculated about 1,100 ExxonMobil employees as well as 14 nursing home patients. El Hawa and Gonzales have pleaded not guilty.

In Alabama, the state Attorney General's Office announced this month that it had cited a Montgomery physician for giving more than 90 fake vaccines. Dr. Zev-David Nash has surrendered his medical license to authorities and is accused of injecting his patients with a harmless saline solution.

According to The Associated Press, Nash gave investigators a box of syringes and a written statement detailing how he substituted the saline solution for flu vaccines at a flu shot clinic he held at a Montgomery bank.

Rosenberg said the complaint in Texas charges El Hawa with attempting to defraud Medicare by administering flu vaccines when none were given.

El Hawa owns Comfort & Caring Home Health and operates two other home health centers in Houston, Rosenberg said. He does not have a medical license and has no formal training or license to dispense medicine. Neither does Gonzalez, whom Rosenberg said worked in a non-medical position in a physician's office and for El Hawa.

Officials said they were trying to determine how El Hawa received the contract from ExxonMobil to administer flu shots at the health fair. (Chicago Tribune)
So the regular (seasonal) flu season in upon us. It is expected to peak in late January or early February. It's not an avian flu pandemic, but it's an opportunity, as seasonal flu hits your community, to ask yourself what it would be like if it were three, four or five times worse. Then get busy in case that happens later this year, next year or the year after.

A good place to start is The Flu Wiki.

Heckuva job, Dennis

In a long, superb, and frankly shocking article in the Wall Street Journal (subscription only), Peter Waldman details how a consultant ghostwriter successfully cast doubt on an important Chinese study of the cancer causing effects of chromium VI.

The story starts forty years ago when Dr. Zhang Jian Dong was sent for "re-education" into the countryside during the Cultural Revolution. The rural area he found had groundwater contamnated by chromium wastes from a state-owned smelter.

The well water was yellow.
People were developing mouth sores, nausea and diarrhea. Dr. Zhang spent the next two decades treating and studying the residents of five villages with chromium-polluted water.

In 1987, he published a study saying they were dying of cancer at higher rates than people nearby. He earned a national award in China for his research. In America, federal scientists translated it into English, and regulatory agencies began citing it as evidence that a form of the metal called chromium-6 might cause cancer if ingested. (Peter Waldman, WSJ, December 23, 2005, p. A1)
Dr. Zhang retired, but in 1997 published what amounted to a retraction of his work in The Journal of Occupational and Environmental Medicine.
For years, scientists thought chromium-6 in drinking water might, at some level of exposure, pose a cancer risk. The first Zhang study, while recognized as flawed, was one reason for this view. Now many scientists think the metal doesn't pose this risk, and once again a Zhang report is a factor behind their view. How risky the metal actually is or isn't matters, because it has shown up in soil or water in parts of 37 states, according to the U.S. Agency for Toxic Substances and Disease Registry.
But now court documents indicate Dr. Zhang didn't write the second article. He allegedly saw a Chinese translation of an early draft, was paid $2000 as a consultant by utility-hired scientists who did write it, and they then slapped his name on it (but not the source of funding or any of the true authors' names). The utilities who paid for it were being sued for chromium pollution.

Dr. Zhang is now dead, but it is known he disputed a statement in the paper that the drinking water was not responsible for the cancers. The revisionist study is now under attack by scientists:
Regulators in California, after investigating the second Zhang report, have concluded it is dubious. They have reverted to the original dark view of chromium-6 and are moving to propose a strict limit on it in ground water. The action could ultimately require a costly cleanup, because a third of wells tested in the state exceed the envisioned limit. Costs would grow if other states followed California's lead.

The conflicting Zhang studies show what can happen when the line between advocacy and science blurs. The consultants pursued the second round of Chinese research with the clear aim of rebutting California plaintiffs' arguments, court documents show. But once that second report entered the realm of peer-reviewed science literature, it took on a life of its own in regulatory assessments of the chemical.

The consultants who worked on the second report defend it as good science. And, rejecting the notion that they ghost-wrote it, they say that Dr. Zhang was kept informed of what it said through phone calls and through an early draft that was translated into Chinese for him.
So we know Zhang only saw an early draft, objected to some statements that found their way into the final version, and his name was falsely (and perhaps fraudulently) affixed to the paper as senior author.

Who were the authors of the study, then? The good folks at ChemRisk, prominent consultants who have become wealthy in the "doubt industry," scientists whose objective is to manufacture uncertainty about science inconvenient for their corporate clients.
A ChemRisk biostatistician wrote in a 1995 internal memo that he foresaw two "products" for PG&E from ChemRisk's work with Dr. Zhang. One was a report that could be the basis for trial exhibits showing "the absence of the association between cancer and groundwater exposure to hexavalent chromium," said the memo. Like many others, it is on file in state court in Los Angeles County, where PG&E -- the defendant in the Erin Brockovich case -- is again facing litigation by residents alleging chromium pollution.

The other product, wrote the ChemRisk scientist, William Butler, would be a report to be submitted to a peer-reviewed journal, with Dr. Zhang as the lead author. Dr. Butler requested a budget of $25,000, which he said would cover 60 hours of his own time to, among other tasks, "interpret data" and "write reports." He budgeted Dr. Zhang's contribution as "research assistance."

Dr. Butler added: "It is at times difficult to convince Dr. Zhang of the importance to us of the specific details of his studies so that we can execute our own analyses."

Three weeks later, ChemRisk faxed Dr. Zhang a draft of a new study of the five villages, translated into Chinese. While reiterating the overall higher cancer death rate, it offered ChemRisk's new analysis saying village distances from the smelter didn't always correlate with death rates. Dr. Zhang wrote back that "I totally agree with what you wrote: 'There is no positive correlation between cancer mortality and the distance of the village to the pollution source or the level of contamination.' "

However, Dr. Zhang had previously told ChemRisk he never tried to assert such a link. And after reading the draft, he told the firm he didn't accept its conclusion that "lifestyle of the residents and other environmental factors unrelated to chromium contamination" might explain the overall higher death rate for the contaminated area.

"This is only an inference; it is inappropriate to consider it as a cause," he wrote to ChemRisk, in a letter filed in California state court. Dr. Zhang instructed the consulting firm to replace that assertion with a vaguer one mentioning several possible variables, as well as the need for more research.

Yet the report, as later published, even more strongly linked the higher cancer mortality to lifestyle and other non-chromium factors. Instead of saying these might be the cause, the published report called them the "likely" cause.

The published report then went further and stated flatly that the higher rate of cancer death in the five villages was "not a result of the contaminated water." Neither stomach-cancer nor lung-cancer deaths "indicated a positive association with hexavalent chromium concentration in well water," the published article said. Neither of those statements was in the draft that was translated into Chinese for Dr. Zhang to read.
These are just a few of the nasty items in Waldman's long and detailed article. If you can get access, read the whole thing. There is another long report at the Environmental Working Group website.

ChemRisk is run by hired-gun toxicologist Dennis Paustenbach, and he was eminently satisfied by the results:
The 1997 article began to influence scientific views. In 2000, the U.S. Agency for Toxic Substances and Disease Registry updated its chromium profile, adding a paragraph about the 1997 study. The passage concluded with the concept Dr. Zhang had pointedly rejected in his memo to ChemRisk. The entry said the 1997 study's authors "commented that these more recent analyses of the data probably reflect lifestyle or environmental factors, rather than exposure to chromium(VI)."

Soon other bodies, such as the Environmental Protection Agency and the California Department of Health Services, also cited the second study to that effect. A 2001 report by a special panel of scientists for the state of California discussed the 1997 paper and concluded there was no need to tighten chromium-6 standards.

Dr. Paustenbach, the ChemRisk founder, served on this panel. He resigned before its report was issued because of a public flap over a perceived conflict of interest, since his firm was a consultant to chromium defendant PG&E.

When the panel's report came out, Dr. Paustenbach emailed it to his former colleague Dr. Kerger, with a note: "Buy a good bottle of wine, pull up a chair...and then read this. Then, say to yourself 'Yep, I really finally did something good for society.' "


Meanwhile, the second Zhang study is still having an influence.

Ore-processing plants in northern New Jersey once produced millions of tons of chromium waste that was used as landfill throughout Hudson and Essex counties near New York City. Chromium-6 has turned up in Jersey City Little League diamonds and, this fall, near the Weehawken-Manhattan ferry terminal.

ChemRisk's Dr. Paustenbach has been instrumental over the years in persuading New Jersey regulators to ease cleanup standards for the metal. An article he co-wrote was cited in a recent New Jersey report that concluded it still wasn't known whether chromium-6 is carcinogenic when ingested. One plank of the Paustenbach argument: that Dr. Zhang's "follow-up study" didn't find a cancer link.
Heckuva job, Dennis. Sigh.

Sunday, December 25, 2005

Sunday Sermonette: a Christmas card

Christmas Sunday. No mail today, but I can still deliver this description of a really delightful--and truly lovely--Christmas card sent out by John Snyder of the Citizens Committee for the Right to Keep and Bear Arms:
Santa Claus points a handgun at a masked terrorist on a Christmas card that John Michael Snyder, public affairs director of the Citizens Committee for the Right to Keep and Bear Arms, sends this year to a number of recipients.

Named Dean of gun lobbyists by The Washington Post and The New York Times, Snyder includes the president and members of Congress as addressees.

The card wishes recipients a Christmas of peace and joy and a New Year of triumph over terrorism.

The card presents Santa guarding a group of small children from a bomb-harnessed suicide killer. The bomber appears ready to cast a stick of dynamite at an image of the Infant Jesus beneath a decorated Christmas tree.

Snyder thinks the original drawing conveys a definitive holiday message in keeping with these difficult times.

Terrorists are out to destroy personal freedom and undermine traditional values associated with Santa Claus and the Christmas Creche, he says. (via USNewswire)
And Merry Christmas to you, too, John.

23 versions of a 22 meme

I got tagged with a meme by Matt Stoller of MyDD, so it's my turn. Here it is:

Four jobs you've had in your life: paperboy; hospital orderly/transport; doctor at an earpiercing clinic; professor

Four movies you could watch over and over: Casablanca; Maltese Falcon; Roger and Me; Salt of the Earth

Four places you've lived: Lund, Sweden; Baltimore; New York City; Cambridge, MA

Four TV shows you love to watch: The Daily Show; Perry Mason (the old series); The Avengers; Beat the Press (Friday version of Greater Boston)

Four places you've been on vacation: Bologna; Paris; Charleston, SC; Barcelona

Four websites you visit daily: Atrios, DailyKos, MyDD, Majikthise

Four of your favorite foods: Spaghetti (almost any sauce); Lasagna (Bolognese version); Corned beef on rye at a NY deli with Dr. Brown's Celray and half sour pickle; Swedish yeast bread with cardamom (Kardemumma bröd)

Four places you'd rather be: Barcelona; Manhattan; Kiawah Is.. SC; Paris

Passing it on to Melanie, DemFromCT, Lindsay, Cervantes

Saturday, December 24, 2005

Chinese bird flu transparency: two steps forward, one step back?

Maybe we spoke too soon. No, we definitely spoke too soon when we noted China's improving reputation for "transparency" on the bird flu front:
A senior World Health Organization official complained Friday that China has not shared with his agency any samples of a deadly bird flu virus strain from its dozens of outbreaks in poultry.

WHO's Asia-Pacific Director Shigeru Omi said that sharing samples of the H5N1 virus is crucial to diagnosing new cases, and to developing a vaccine that could prevent a possible pandemic in humans.
China's Ministry of Agriculture shared five samples collected from infected birds last year but has failed to provide any this year, Omi said.

"From the more than 31 reported outbreaks in animals from 2005, no (Chinese) viruses have been made available so far for the international community," Omi said. "Time is of the essence."

China's Ministry of Health agreed this week to give the WHO samples isolated from two of its six confirmed human cases of bird flu.

Jia Youling, director of the Chinese Agriculture Ministry's veterinary bureau, which has led China's efforts against bird flu, declined to respond to Omi's remarks. He referred questions to his ministry's press office, which did not return phone calls. (AP via Mercury News)
What is somewhat odd about this report, however, is that it was also reported this week that the Chinese had handed over some viral samples from recent human cases. Apparently the way to reconcile these reports is that they have handed over none of the poultry viruses.

Trying to unravel the genetic changes affecting the poultry panzootic in asia is critical to tracking the the virus and its pandemic potential.
Scientists have determined that bird flu strains in Vietnam and Thailand resemble each other, while a distinct second strain has affected birds in China and Indonesia.

A potential third strain may have affected birds and sickened at least one human in northeast China's Liaoning province, Omi said.

"The outcome of this battle in China has ramifications not only for the region but also for the entire world," he said. "Maybe in China there are two sub-strains, maybe more," he said. "We don't know."
Well maybe the Chinese know. It would be nice to share the knowledge, or if they don't have it, provide samples for others to generate.

This is not a question of withholding genetic sequence data, which apparently the Chinese have provided. The problem is connecting the sequence data with the biology--for example host range, virulence, etc. This cannot be done from the sequences alone, at least not yet. As we noted in another post, there can be complicated reasons for not sharing the actual virus--reasons related to commercial exploitation, fear of having one's "resource" appropriated by foreign laboratories or countries, national pride, etc. Whatever the reasons--and some of them no doubt have merit from the Chinese point of view--it is time to put them aside, perhaps with some explicit codicil to protect whatever concerns the Chinese have.

No one knows how much time we have to generate the information that will help the world cope with a possible pandemic. But the more time and the more heads and hands working on the problem the better off everyone will be.

Friday, December 23, 2005

Benzene out, cadmium in

Now that the huge slug of benzene has flowed out of China and into Russia on the Songhua River, it's time to pollute again. Now it's a zinc smelter in the south that discharged massive amounts of cadmium into the Beijiang River, shutting down the drinking water supplies of several cities.
A resident contacted by telephone in Shaoguan, in the far northern section of southern Guangdong province, said water was cut off all day Tuesday. The taps began running again about 5 p.m., she added.

The official Guangdong television station warned residents at certain points downstream not to drink tap water drawn from the river, which runs about 300 miles southward through the heavily industrialized province until it spills into the Pearl River.

In Yingde, a city of 1 million people 60 miles south of Shaoguan, officials started building a mile-long water pipeline to connect the threatened downtown area with a suburban reservoir isolated from the river-borne pollution, the official New China News Agency reported.

An unnamed government official told the agency that the pipeline should be completed before the polluted waters reach the city distribution system, which is expected to be sometime Thursday. In addition, he said, fire engines and other tanker trunks have been mobilized to carry water to the downtown area, and upstream reservoirs have released water into the river to dilute the pollution. (WaPo)
Amazing. They are trying to dilute the poison in a river by discharging clean water from fire engines and tanker trucks. That's a new one on me.

The state-owned smelter has offered no explanation for the high cadmium levels in its discharge or why they didn't take more care. In the true spirit of American capitalists, they have blamed some of the pollution on other chemical factories on the river.

A reminder to China's burgeoning consumer class: Be careful what you wish for.

The Book of Whitey

The Book of Whitey could also be called, How the Zebra(fish) Lost its Stripes. Researchers at Penn State have found a mutation in a gene called slc24a5 in zebrafish that results in the loss of its characteristic stripes. they also found the gene has counterparts in many other species, including chickens, dogs, cows and most notably, humans. A protein produced by the gene is responsible for accumulation of melanin pigment in skin cells. When a single letter in the gene's genetic code is changed, the protein cannot perform its ion exchange function, leading to a loss in melanin accumulation. The zebrafish's black stripes disappear. In humans, dark skin turns lighter.
Scientists said yesterday that they have discovered a tiny genetic mutation that largely explains the first appearance of white skin in humans tens of thousands of years ago, a finding that helps solve one of biology's most enduring mysteries and illuminates one of humanity's greatest sources of strife.

The work suggests that the skin-whitening mutation occurred by chance in a single individual after the first human exodus from Africa, when all people were brown-skinned. That person's offspring apparently thrived as humans moved northward into what is now Europe, helping to give rise to the lightest of the world's races. (WaPo)
Human slc24a5 has two principal alleles (different genetic forms) that differ by a single amino acid at position 111 of slc24a5's third exon. The dark-skinned allele has alanine and the lighter-skinned one has threonine (paper in Science (pp 1782, - 1789, v. 310 [16 December 2005]). This single difference accounts for about a third of the skin color variation between Europeans and Africans. Other genes are likely also involved, leading to the many shades in skin color.

What's the take home lesson here? I suppose one way to put it would be to say whites are genetic freaks that had the luck to settle in a geography highly favorable for economic development (the thesis of Jared Diamond's stimulating book, Guns, Germs and Steel). But another would be that a genetic difference associated with a major racial feature, skin color, is so small as to be trivial (in this case a single amino acid change).

Take that as both a scientific and a political statement.

Thursday, December 22, 2005

The magic bullet loses some of its magic

[NB: This post is perhaps more technical than some readers would find comfortable, but I wanted to register some ideas I didn't think were being adequately or at all covered elsewhere.]

A second New England Journal of Medicine (NEJM) paper from Vietnam detailing oseltamivir (Tamiflu) resistant H5N1 has just appeared and it is more ominous than the first, which described partial resistance in a patient that eventually recovered (see other posts here, here and here). The case reports today describe two more patients with fatal outcomes carrying a virus that was resistant to H5N1, as evidenced by continued viral load in the presence of recommended and timely treatment regimens and a mutation (H274Y) previously described as being related to Tamiflu resistance (in volunteers experimentally infected with H1N1; Gubareva et al. J Infect Dis. 2001 Feb 15;183(4):523-31.). It does not appear that any direct tests for Tamiflu resistance were done (such as NA inhibition or plaque assays in MDCK cells).

The paper is available for free download here (.pdf). Here are the points that struck me on first reading.

There are some important similarities between these cases and the volunteer infections with the (clinically safe) H1N1 reported earlier by Gubareva. In that experiment 54 infected volunteers were treated with Tamiflu doses of 20 mg, 100 mg and 200 mg/day. The viruses in two of these volunteers (4%) became resistant to Tamiflu on assay, and viral loads in both showed an initial decline followed by a rebound, similar to the cases described in today's NEJM article. Both were unique in carrying the H274Y mutation at the neuraminidase active site. Moreover, the two resistant cases were those on the highest dose of Tamiflu (200 mg/day), not the lowest as I would have guessed a priori. The current therapeutic recommendations for Tamiflu are 150 mg/day, so the resistant H1N1 viruses in the Gubareva study exceeded current dosing. In the earlier Vietnamese case of partial resistance, the young girl was initially treated with a prophylactic dose of 75 mg/day and when she became symptomatic this was increased to 150 mg/day and she recovered. These disparate findings leave us still in the dark regarding the influence of suboptimal dosing on the emergence of resistance.

Another point of interest was the co-existence of the H274Y mutant and wildtype H274 in the throat swabs, but a finding of only H274Y mutants in the MDCK cultured isolates. One of the issues that has hung in the background of Tamiflu resistance was whether resistant viruses are less fit genetically than wildtype. At least in terms of the ability to grow in tissue culture MDCK cells, the resistant virus was more fit, not less fit. However the relation of in vitro measures like growth in tissue culture and the replication of the virus in whole animals is still unclear. But given the clinical outcomes here, these cases do not give reason for optimism.

Tamilfu resistance is known to develop fairly quickly in Japanese children but rarely in adults treated for H3N2 infections. As this paper points out, this might be a reflection of some immunologic protection in adults and not children. This would mean that in contrast to the Japanese experience, Tamiflu resistance might just as easily develop in adults as children, since no one has any prior experience with the virus.

We note that the principal case described here was a 13 year old Vietnamese girl who develop symptoms a day after her mother died of H5N1. This would qualify as a family cluster, although no other historical information was given.

The bottom line, however, should be obvious (although it isn't a part of the news coverage so far). The best protection against the most serious effects of an epidemic infectious pandemic is not a magic bullet pharmaceutical like Tamiflu or biological like a vaccine, but a sturdy, effective and adequately supported social services and public health infrastructure. Tamiflu was never going to get us that far in mitigating the effects of a pandemic anyway because our ability to supply, dispense and provide the collateral medical support was never there. Nor could it be effectively used on a mass population basis. A vaccine, were one available, would be better, but there is an inevitable lag time between the emergence of a pandemic strain and the ability to produce and distribute the vaccine (the latter of which of course depends on a public health infrastructure). The lag is sufficiently long that a whole pandemic wave could wash over the globe before the first of a vaccine was administered. And the reliance on the private sector to provide lower profit biologicals has failed us time and again. It is time to try using public means to produce them. Finally, there is no guarantee a pandemic or epidemic organism will be H5N1 or even influenza. Tamiflu is an influenza/A specific pharmaceutical. It is worthless against any other infectious disease that might come along.

It is not just a matter of "putting all our eggs in the same basket." It is a matter of having neither eggs nor basket nor any way to distribute them. Dismantling our hospital, medical care and social services systems has left us defenseless. The likely evidence for the emergence of Tamiflu resistance is just another one of the obstacles we face, and in the Big Picture, probably one of minor importance.

China's virus, China's vaccine

The best indicator of the cloud of suspicion over China are news stories about how forthright they now are. A case of damning with belated praise, but better late than never:
"There is a definite willingness to be completely co-operative, be completely transparent and to exchange samples with the WHO and with other partners so we can track the genetic changes," Elias Zerhouni, director of the National Institutes of Health, said when commenting on the current bird flu control effort in China.

In addition to transparency, China has tremendously increased the amount of scientific involvement in the prevention and control of the infection, he told a news conference in Beijing.(People's Daily)
The praise comes in the context of a new agreement whereby China will share virus samples from H5N1 cases, something they had not done previously. A draft agreement between WHO and the Chinese Ministry of Health fulfilled a pledge made two months ago at a bird flu summit in Ottawa. Now comes word the first samples from recent human cases have been handed over to WHO by China's CDC. This is good news. Let's hope the cooperative attitude continues.

The Chinese also report they have begun their own clinical trials of an experimental H5N1 vaccine. Trials in animals reportedly showed an immune response. The initial Phase I trials will examine safety, efficacy, optimum dosage and schedule. The British National Institute for Biological Standards and Control (NIBSC) provided the seed strain and the first 6 of 120 Beijing volunteers (aged 18 - 60) have just had the vaccine administered. Trials are expected to last 9 months, but preliminary Phase I results will be available in . The Reuters article reporting the trials had no details on tested dosages and schedules or whether the vaccine contained an adjuvant. The vaccine is being made by the Chinese company, Sinovac.

The more trials with experimental vaccines the better, as we are pretty much in the dark at the moment. It is helpful if additional trials confirm what has been done elsewhere, but we also need more trials with adjuvants and we believe it is useful to consider intradermal administration. We await the Chinese results with interest.

A tale of two Chertoffs

Johnny Carson started his TV career as the host of the show, "Who do you Trust?" One answer that is clearly wrong is "Michael Chertoff."

From the AP via The Guardian (anybody see this in the US press? h/t Melanie):
Internal meeting notes released by a union official say Homeland Security Secretary Michael Chertoff told employees that many changes planned for federal disaster response were a public relations ploy.

The purported statements were in typed notes issued Tuesday by a union representative for federal emergency workers. A Homeland Security Department spokesman said Chertoff considers the post-Hurricane Katrina changes one of his highest priorities and never would have made such comments.

Under the heading "Retooling/Chertoff's remarks,'' the typed notes said, ``The re-tooling is partially a perception ploy to make outsiders feel like we've actually made changes for the better.''

The notes were released by Leo Bosner, president of the American Federation of Government Employees local that represents headquarters workers at the Federal Emergency Management Agency. FEMA, once independent, is now part of the massive Homeland Security Department.

Bosner said he obtained the notes from another FEMA official, whom he would not identify.
Not surprisingly, Chertoff's spokesthing categorically denied it. Even more, Chertoff gave a speech Tuesday saying FEMA was due for a "radical" makeover.
"We will retool FEMA, maybe even radically, to increase our ability to deal with catastrophic events,'' he said in a 35-minute speech at George Washington University.
Chertoff offered no specifics for changing FEMA but said its employees must be given authority to cut through bureaucracy to assist disaster victims quickly.

His aides said changes will come early next year.

It was unclear whether any of the changes will require legislative action, or if Chertoff will move before Congress returns to Washington in late January. A special House inquiry of the government's response to Katrina, chaired by Rep. Tom Davis, R-Va., is expected to issue its findings by Feb. 15.
Legislative action? Who needs Congress. We just heard from the Commander-in-Chief himself that the Afghanistan resolution gave him authority to do whatever he wants to to ensure the safety of the country. Since Homeland Security will be the Overlord Agency in a pandemic, they can march into a locality and take over from the state and local officials to maintain civil order. And they will decide when it needs to be done.

So which Chertoff do you trust? The one that says changes are just public relations? Or the one that says big changes are in the offing. None of the Above? or, All of the Above?

Wednesday, December 21, 2005

Sign here, I'll fill in the amount later

Tomorrow the Republican Senate is slated to vote on the defense appropriations conference report. It has passed the Republican House. This is the bill that has oil drilling in the Alaskan Wildlife Refuge, the vaccine and drug industry liability immunity provisions, and only half the President's request for bird flu in it. Defense appropriations. Get it?

It's a so-called "must pass" bill loaded down with GOP stinkers. Big oil got its gift through demented political hack Senator Ted ("Bridge to Nowhere") Stevens, representing Alaska. The drug industry's liability immunity Christmas gift came from Quack Senator Bill Frist, representing Big Pharma (and in his spare time, sometimes Tennessee). But he didn't get it there by coercing or convincing members of the conference to sign the report that contained it. Apparently he inserted it after everyone signed it. Thus many Dems were reduced to scrawling remonstrances later.

Here's more, from
Frist inserted into the DoD conference report a provision granting incredibly broad legal immunity to drug manufacturers involved in fighting avian flu. He happens to own a bit of stock in at least three companies that will benefit from the provision.

Also, Don Rumsfeld owns millions of dollars in stock in the patent holder of tamiflu. If Frist's immunity provision passes through the Senate, it'll be basically immune from prosecution. If you haven't followed Rumsfeld's Tamiflu conflict, definitely read here.
How will Frist benefit?
At minimum, he has three interests that would directly benefit from the vaccine immunity provisions. First, he owns more than a thousand dollars worth of stock in Abbott Laboratories. Abbott produces the antibiotic Biaxin, used to treat flu-related secondary infections, expected to be used in avian flu treatment regimes. In what is certainly a mere coincidence, the FDA just issued a public warning about the Biaxin, as a study seems to show it killing a fair number of people. Those people would be left high and dry by Frist’s legislation.

Second, he owns more than a thousand dollars of stock in Johnson & Johnson. J&J partnered with BioCryst in the production of peramivir, an anti-viral that could be part of any anti-Avian flu regime. While it looks like J&J has given up its rights to peramivir, as we saw with Gilead, marketing and production agreements are “flexible,” to say the least.

Third, he owns more than a thousand dollars of stock in Proctor & Gamble. P&G has partnered with Sanofi-Aventis, the French pharmaceutical company already contracted by the government to develop an Avian flu vaccine. (
As for the provisions themselves, they eliminate gross negligence as a cause of action and require "willful misconduct," an unrealistically high bar for victims.
These provisions are broad. Incredibly broad. They will require anybody injured by any “drug, biological product or device that is used to mitigate, prevent, treat, or cure a pandemic or epidemic or limit the harm such pandemic or epidemic might otherwise cause” to prove that the harm derived from “willful misconduct” rather than negligence. If you’ve got an hour, you can read the provisions in this incredibly large pdf, starting on page 423, proceeding through page 463.
Since there was only 40 minutes of debate on the entire bill, I don't think any members read it before voting.

This certainly makes success in Iraq more likely, if the standard is a democracy like ours.

WHO Handbook for Journalists online

WHO has just published a bird flu Handbook for Journalists. It is available as a .pdf online. I just read it.

What to say? The information is basic and none of it news to a regular reader of this site or other sites that discuss bird flu. It provides a naive journalist the absolute minimum of information. It can be read in less than an hour, probably in 45 minutes. It has links for WHO resources, but no others. It appears accurate, with two exceptions.

The first is relatively minor. The sources of genetic variation are mentioned, but poorly explained. Moreoever, genetic drift is termed "adaptive mutation":
A pandemic virus can emerge via another mechanism, known as "adaptive mutation," in which the viruses gradually adapt, during human infections, into a form progressively easier to spread among humans. (p. 2)
This may have seemed like a more descriptive term than genetic drift to the writer, but unfortunately "adaptive mutation" in genetics refers to the dependence of mutation frequency on environmental conditions, for example, environmental stress inducing E. coli to mutate more frequently (in a much studied model). This has a Lamarckian flavor and has been highly controversial in microbiology. In any event, the random process intended, whereby mutation is independent of its consequences and the environment, is not "adaptive mutation" and journalists shouldn't use that term.

The second, more important, concern is in the description of the experimental H5N1 vaccine (p. 8):
Several companies have begun work on a potential pandemic vaccine, using the WHO "seed" stock, that is based on the H5N1 strain circulating in Viet Nam. In August 2005, US researchers announced preliminary results from an experimental pandemic influenza vaccine, that provoked a strong immune response in humans in a clinical trial. This development should cut the lead-time needed to produce a vaccine from four to six months to two to three months.
To say the experimental vaccine provoked "a strong immune response" is misleading. Indeed, as we have noted here, the amount of antigen needed to achieve adequate response is twelve times what is needed for ordinary seasonal vaccine. The recent attempt to strengthen this weak response by using an alum adjuvant was disappointing. The Handbook gives the impression we are well on the way to an effective H5N1 vaccine, but there are many obstacles yet to overcome and we don't know how long it will take to overcome them. In my view this is a serious bit of misinformation for science journalists.

The Handbook is a reasonable effort to educate a reporter who knows almost nothing about bird flu. After reading it, a reporter will know the minimum but not much more. That's better than nothing. But not by a lot. The information is available in many newspapers. WHO could have aimed higher.

Tuesday, December 20, 2005

The criminals amongst us, Part II

I was going to add this as an Addendum to the post on the release of Dr. Germ and Mrs. Anthrax, "The criminals amongst us," but decided it was worth its own post. The title of my earlier post was deliberately meant to impugn the integrity of many scientists in this country who work to make bioweapons. I view them as I do the Iraqi low-lifes, Dr. Germ and Mrs. Anthrax. Then Cervantes (our esteemed blogger colleague of Stayin' Alive) drew my attention to this superb piece by Tom Engelhardt in on the anthrax attacks of 2001. Here is a long excerpt germane to the issue I raised:
If, as an editor of a major newspaper, you were to draw a single conclusion from [the anthrax attacks of 2001], it might be: Despite what we've heard, the greatest WMD danger to Americans comes not from impoverished Third World or rickety Middle Eastern rogue states, but from the arsenals and weapons labs of the two former Cold War superpowers. But nothing in the media coverage since then has indicated anything of the sort. While, prewar, reporters prowled Iraqi nuclear facilities, wrote major pieces on Iraq's "Dr. Germ," and brought down whole forests of trees in the service of WMD programs at Iraq's Tuwaitha or North Korea's Yongbyan, or on gassed dogs in Afghanistan and the Iranian bomb that also wasn't, the Soviet and American weapons labs, the Soviet and American Dr. Germs, the Ames anthrax strain, and the anthrax killer hardly took out a tree or two.

When was the last time you read a major report on the state of American biowarfare work? When was the last time you encountered a significant story about the weapons labs at Fort Detrick in suburban Maryland where the Ames strain was evidently first researched or the Dugway Proving Grounds in Utah where it was produced and tested? How much attention has been given to recent contracts linked to Dugway that signal a desire on the part of the U.S. military to "buy large quantities of anthrax, in a controversial move that is likely to raise questions over its commitment to treaties designed to limit the spread of biological weapons"? When was the last time you read an article on whether the Homeland Security Department or the Pentagon is attending to the potential dangers of the American WMD arsenal? How much attention has gone into the decrepit system for locking down Russian WMD stocks? The odd news piece, nothing more. And while this administration spends about a billion dollars a week on its war in Iraq, it has hardly had the will or interest to raise the few billion dollars a year needed to help lock-down the Russian arsenal. Imagine that. If, of course, the President had chosen to launch his "war" on terror against the anthrax killers, this might have been our top priority.

Since September 11, 2001, weapons of mass destruction have been dealt with purely as a danger from the peripheries, not as a heartland issue. In fact, the Bush administration has successfully focused all our WMD attention and fears out there, not in here. The Iranian bomb -- at best, years away according to the latest National Intelligence Estimate -- has been the singular focus of the world's attention; while the nuclearized "global strike force" the Pentagon has been preparing for future use in Iran, North Korea, or elsewhere is barely attended to.

Now, here's the interesting thing: Because this administration had its eyes set on the Middle East from the beginning, it essentially chose its terror war from column A (the September 11th attacks), not column B (the anthrax attacks, once it became clear that they were connected not to al-Qaeda but the American arsenal). Hence our control group. Here, for instance, is a very partial list of actions not taken by this administration in relation to the anthrax attacks:

Our President never swore to get the killer(s), "dead or alive." He kept no profile of the possible killer or killers in his desk drawer, so he could cross him/them off when caught. The President, Vice President, National Security Adviser, and others did not warn the public and Congress regularly of the possibility of "clouds of anthrax" being released in our major cities (though this had, after a fashion, already happened) even as they were issuing dire warnings about fantasy Iraqi unmanned aerial vehicles or UAVs that might at any time spray biological or chemical weapons over east coast cities. (Democratic Senator Bill Nelson of Florida, for example, said that he voted for the administration's resolution authorizing force in Iraq because "I was told not only that [Saddam had weapons of mass destruction] and that he had the means to deliver them through unmanned aerial vehicles, but that he had the capability of transporting those UAVs outside of Iraq and threatening the homeland here in America, specifically by putting them on ships off the eastern seaboard.") No American planes swooped down to bomb the weapons labs of Fort Detrick or the Dugway Proving Grounds; the only suspect publicly identified, while hounded for a period, was never declared an "enemy combatant." No one seized and rendered him; no CIA agents swept him from the street, cut off his clothes, shot him up with drugs, slipped him into an orange jumpsuit, whisked him onto an unregistered plane, and took him to a secret prison in Egypt or elsewhere to have "the truth" beaten or waterboarded or otherwise tortured out of him. Nor did he end up incarcerated in Guantanamo for years, trial-less and beyond the reach of the courts. Quite the opposite, Hatfill is suing former Attorney General John Ashcroft, the Justice Department, and others for violating his constitutional rights and the New York Times for defaming him.

Nor, in the wake of the anthrax attacks, was any kind of global war declared on the killer or killers, or troops deployed anywhere. In fact, no drastic actions of any sort were taken. In the wake of the attack, the post office became more careful; U.S. weapons labs were assumedly better secured; and remind me what else occurred in response to one of the most dangerous attacks in our history? Beyond the dead and injured, the panic of the moment, and the monumental costs of cleaning up congressional offices, newsrooms, and post offices, what were the costs?

As it turns out, the Bush administration acted in response to 9/11 in every wild and extraordinary way -- and in response to the anthrax attacks in next to no way at all. Put the two together and what you can see is the degree to which the costs of 9/11, whether in Iraq or at home, are the responsibility not of the attackers, whose damaging acts were violent in the extreme, spectacular, and limited, but the Bush administration.
Read the whole thing. Worth it.

The criminals amongst us

In May of 2003 the US announced it had captured two "high value" subjects central to Saddam Hussein's biological warfare establishment, Rihab Taha ("Dr. Germ"), the program director, and Huda Sallih Mahdi Ammash ("Mrs. Anthrax"), a top scientist in Taha's program. Last week they were released:
"We no longer had cause to hold them since they are no longer under investigation for crimes," [military spokesman, Lt. Col. Barry] Johnson said in a statement.(CNN)
So after being held for two and a half years they were released, without fanfare, because they weren't under investigation for crimes. So as far as the US government is concerned these aren't criminals--legally speaking. Not that the US government gives a shit about the letter of the law when it comes to detainees, of course. They were no longer of interest, for whatever reason.

Leaving aside the shameful disregard of due process and civilized behavior US authorities exhibit with regard to detainees, from my perspective, both of these scum bags are still criminals. They used medical science to devise ways to kill people.

But that's just me. If this were really a criterion for criminality, just think of the crime wave we'd have.

Praise Big Pharma and pass the ammunition

Is half a loaf better than none? Depends which half.

The US House of Representatives has approved $3.78 billion for bird flu, half of what Bush asked for. Full funding was blocked by conservative republicans in the House who demanded offsets from other programs.

Meanwhile Dr. Frist, the long-distance diagnostician, has gotten up close and personal once again with Big Pharma:
Following hours of late-night negotiations between top Republicans in the Senate and House, Senate Majority Leader Bill Frist of Tennessee succeeded in including a provision to protect vaccine, drug and medical device makers against lawsuits in a public health or bioterror emergency.

The avian flu funding was attached to an unrelated defense spending bill passed by the House by a vote of 308-106 that faces an uncertain future in the Senate later this week.

Consumer and health groups opposed the vaccine liability provisions, which were sought by pharmaceuticals, saying it would protect companies from "gross negligence."

Some lawmakers said the measure could make medical personnel and other emergency workers reluctant to get vaccinated if there was a chance they could suffer negative reactions and not get compensated.
The language "gives carte blanche to the vaccine companies, but doesn't provide a mechanism" for people if they are injured by a vaccination, said Rep. Dan Burton, an Indiana Republican. (Reuters)
As noted at Pittsburgh bloggers:
The details are yet unclear, as the Congressional Record hasn't updated for last night, but AP and Reuters are reporting the general gist: Sen. Frist, ignoring calls by Democrats to merely place any bird-flu vaccine on the list of those covered under the National Vaccine Compensation Fund, set up two decades ago to compensate children injured by routine childhood shots, wants even stricter liability coverage for vaccines yet unproved to even work, let alone be safe.
I'm sure the troops will feel the love from this defense bill when they find out damages from experimental vaccines (like the anthrax vaccine debacle) are just their tough luck.

Monday, December 19, 2005

Is the flu vaccine problem only skin deep?

In an earlier post on the relatively disappointing results from the H5N1 vaccine trials with alum adjuvant, a commenter (Joseph B.) asked about another way to stretch the vaccine, intradermal administration. It was an excellent question. Here is the rationale for this technique.

Skin, unlike muscle, is well supplied with dendritic cells (specialized immune cells that process and present antigen). If dendritic cells are given the opportunity to process the viral antigen in vaccine, we might be able to use far less than for conventional intramuscular injection, which, while slightly easier to perform, essentially by-passes an important immunologic organ (the skin) and is thus inefficient.

Last year during a vaccine shortage, caused by half of the US vaccine supply going down the crapper because of contamination in Chiron Corporation's UK vaccine facility, intradermal administration was tried in Belgium and at St. Louis University Medical Center.
One study—supported by a grant from GlaxoSmithKline—was conducted at St. Louis University and recruited 238 participants: 130 men and women ages 18 to 60 and 108 who were 60 or older. Each age-group was further divided to receive either the intramuscular influenza vaccine (69 in the younger group and 50 in the older group) or the intradermal vaccine (61 in the younger group and 58 in the older group). The intradermal vaccine was administered using a tuberculin syringe and needle and contained approximately 40% of the antigen needed for one 0.5-mL dose of the intramuscular vaccine. Both of the vaccines contained one strain of influenza type A (H1N1), type A (H3N2), and a type B virus.

The other study was conducted by Iomai Corporation—a company that develops transcutaneous vaccines. The investigators used data from a larger Belgian study of influenza vaccination in healthy men and women. The researchers used results from the open-label, randomized portion of the study that evaluated different routes of administration for their safety and efficacy. In this study, the intradermal vaccine contained 20% of the antigen in the intramuscular vaccine. One hundred patients ages 18 to 40 were enrolled (50 in each group), and both groups received a vaccine that included two type A (H1N1 and H3N2) viruses and two type B viruses. (
Protection was assayed by determining the extent to which serum prevented the virus's usual ability to clump (hemagglutinate) red blood cells after three weeks. There were some differences between the IM and ID groups in one age group, the over 65 year olds, where the ID vaccine response was lower than the IM group in St. Louis but higher than the IM group in the Belgian study. Overall, titers were higher for the IM group but both groups had comparable in their ability to produce protective antibody titers.

The recently reported adjuvanted vaccine stretched supplies by a factor of three over conventional seasonal flu vaccine, but since the H5N1 vaccine required a twelve-fold greater amount of antigen spread over two doses a month apart, the current vaccine production capacity still would be cut by three-quarters. Intradermal injection provided up to a five fold improvement in seasonal vaccine use. It isn't clear whether it could be combined with adjuvant for a still greater increase, but in any event it seems the intradermal route is worth looking at. Intradermal injection uses different needles and a different technique, but it isn't hard to learn. It took me about five minutes to learn it for TB skin testing when I was a medical student.

The pity of all this is that we took so long to get started on this when the problem was visible years ago. With a properly functioning federal public health establishment (one that doesn't screw up flu vaccine supplies every year), we could have known the answers to some of these questions by now. (Every time I say something like this a commenter complains I am making a partisan swipe at the Bush Administration. Yes, I am. Because they deserve it.)

The St. Louis studies were reported in the New England Journal of Medicine on November 3, 2004, the Belgian studies in JAMA. 2004;292:2089-2095.

Afghanistan was wrong (too)

Having just endured Bush's speech on Iraq, it occurred to me it is time (again) to mention Afghanistan, the dress rehearsal for Iraq.

It is commonly said we were justified to go into Afghanistan because "they" were the ones who attacked us, contrasting it with the misdirected attack on Iraq who had no role in the 9/11 attack. I beg to differ. Not on the Iraq part. On the justification for attacking Afghanistan.

First let me get the (tiresome) disclaimers out of the way. I am not in favor of a Taliban style regime (hence I am not a big fan of Saudi Arabia or the current regime in Iran). Nor was I a supporter of Saddam Hussein. Nor, for that matter, am I a supporter of Robert Mugabe or Kim Jong Il or Pervez Musharraf or Putin or the Chinese oligarchs. They are bad (sometimes evil, if I may be so bold as to purloin that word from Fearless Leader) and have done incalculable harm (at least I don't want to try calculating it). The question is, does that justify bombing the living shit out of their countries and then occupying them?

Afghanistan is different, you might say, because they attacked us on 9/11. Not as far as I know. Taking the Administration's word for it the most the Afghan government did was provide a safe haven and moral support for those who did attack us. If that kind of support for terrorists were warrants for attacking a country, then we would have also (or instead) have attacked Saudi Arabia and Pakistan (instead of giving them special favors).

Yet our sole justification for attacking Afghanistan was that they physically harbored terrorists who attacked us. As President Bush said after the 9/11 attack, we will go after any country that provides safe haven for terrorists, any terrorists. This is a global war on terrorism. There are to be no exceptions.

Except, of course, there are numerous exceptions. We don't attack Florida for giving safe haven to anti-Cuban terrorists. We didn't let the British attack South Boston because it was a hotbed of IRA sympathizers, supporters and financiers. We don't bomb Montana because it harbors anti-government militias of the type that killed 168 Americans in the Oklahoma City bombing. No, instead we attacked Afghanistan because it was essentially defenseless, was geopolitically important (at least the Russians thought so), it was politically expedient for our military-record challenged President to show how tough he was and it was a neocon warm-up for the main show, the planned establishment of American military power in Iraq. There is no global war on terrorism, of course. Just more neocon imperial policy.

Attacking Afghanistan was wrong (too).