The Kaiser Family Foundation has a new resource for global health. While new, it features plenty of handy information for us global advocates, such as a map of cumulative cases of H1N1 influenza (the subtype of influenza A causing swine flu), convenient fact sheets on U.S. Global Health Policy, and a policy tracker in which you can follow up on the latest global health legislation.
Reporting live from Manhattan…
We aren’t quite running down the streets with masks on our faces panicking yet (which, it’s not clear how good of an investment they are anyway; see Susan’s comment on masks on the previous flu post), but we did close four schools, as the number of confirmed cases in New York City rises to 51, the first US swine flu death is confirmed in a toddler in Texas, and the World Health Organization raises the pandemic alert level to Phase 5. The net worldwide case count is uncertain due to re-testing of previously identified cases in Mexico.
City health agencies are concerned about the effects of recent downsizing due to the recession on their ability to function at top form:
At a news conference on Monday, Dr. Richard E. Besser, the acting director of the federal Centers for Disease Control and Prevention, said the public health system was in “a tough situation.”
“We hear about tens of thousands of state public health workers who are going to be losing their jobs because of state budgets,” he said. “It is very important that we look at that resource because this outbreak was identified because of a lot of work going on around preparedness.”
But according to John M. Barry, author of The Great Influenza, now may be a reasonably good time to catch the bug.
For further reading while you’re holed up in your room ordering delivery and avoiding crowds:
On Monday April 27, 2009, President Obama named Eric Goosby, MD as the new global AIDS coordinator and administrator for the President’s Emergency Plan for AIDS Relief. Dr Gossby is a professor of clinical medicine at the
Dr. Goosby began his career treating patients at
See the White House press release and New York Times report (Macfarquhar, New York Times, 4/27) for more on this story.
BBC has a nice interactive map that shows the spread of swine flu at different points since the first cases were identified:
Amidst the calls for readiness and the necessity of prompt public health action, Governor Kathleen Sebelius of Kansas has been confirmed as the US Health and Human Services Secretary.
The UN’s Food and Agriculture Organization (FAO) has announced it is sending a team to investigate claims that industrial pig farms in Mexico were the source of the outbreak. Meanwhile, the Internet is aswarm with swine flu rumors ranging from the plausible to the outrageous (as well as a gratuitous number of attempted puns involving pigs and flying). A sampler (with source): the outbreak’s name should have nothing to do with pigs (US pork producers; also the government of Israel); the virus was secretly created in US labs in a bid for world domination (Indonesia); avoiding pork chops will protect you against it (Twitter; also a number of world governments); so will enemas (The Huffington Post); so will getting drunk (xkcd.com, point your mouse over the image). OK, so maybe the last one is just there to lighten the mood. But seriously, people. While we marvel at the fascinating cultural beliefs and geopolitical realities that underlie these rumors, do let us try and stick to the science when it comes to disseminating information.
Seen any fantastic swine flu rumors or controversies out there? Please add them in the comments!
A recently published article in the Economist reveals an experimental new technique to combating malaria. The problem with many existing pesticides aimed at reducing the number of mosquitoes is that they quickly evolve resistance. To circumvent this problem researchers are testing a fungus which takes 10-12 days to kill infected anopheles mosquitoes. Because the fungus kills its host after it has had time to reproduce, there is far less evolutionary pressure to develop resistance. The plasmodium parasites require several days to infect mosquitoes (they are not present in the mosquito at birth, but must be acquired by biting an infected person) and grow to maturity. The fungal insecticide aims to kill adult mosquitoes before the plasmodium protozoans can mature, but after the reproductive cycle of the mosquito. If it works, researchers estimate that it could reduce infectious bites by up to 95%.
On the 17th of April, the Obama administration proclaimed the new doctrine that carbon dioxide is bad for our health and circumstance. Not much of a revelation for many in the fields of public health, but certainly a bold move politically. With this announcement, and the Clean Air Act already in play, the EPA can step in and begin regulating emissions with the blessing of the Supreme Court and Executive branch. The Financial Times writers, Andrew Ward and Sarah O’Connor, offer a brief synopsis of it in their article “US declares carbon dioxide a danger to human health”.
I find the maneuver encouraging, but we are still at least one large step from doing much of anything tangible to curb emissions…and a chasm away from doing it right.
Does the Obama administration really want the EPA to handle CO2 admissions? I doubt it. In fact, the real bite of this new axiom and emboldened EPA has already been noted by much of Congress: it’s twisting the screw to get them to pass some legislation. It is always more pleasant for an elected official to vote for the obvious than vote for the confrontational. Naturally, some of them are quite uncomfortable with the Obama camp turning up the heat on potential environmental legislation (perhaps that will make them more empathetic to the scientific community’s discomfort with the world’s rising temperature). Notwithstanding some Congressional pleas that Obama isn’t playing fair, the legislative branch will now have to take a long, serious look at the current cap-and-trade proposal. Before, it was just a matter of voting down something they (and some lobbyists) didn’t want any part of. Now, it means forfeiting a market-based system of regulation for an executive agency book of mandates (you can almost hear the far-right teeth grinding…environmental protection, bigger government…they haven’t experienced such agony since the 70s).
But will cap-and-trade do it? Maybe, but I’ve got my doubts. I should moderate my demur with a caveat: it probably will do something, it just might not be much. Briefly, this system aims to declare a national ceiling on emissions, slice the total up like a pie and distribute them to every corporation that pollutes. Those that need more permits (slices of pie) will have to buy them from others, who have permits to spare. Ideally, it keeps the total emissions at an agreed upon level and encourages innovation (i.e. do what you can to need as few permits as possible and sell the left-overs). Not so bad thus far, but the tricky part comes next. PRICING.
The conundrum of this particular proposal is putting the right price tag on the permits. Aim to low, and they become so cheap that nobody changes behavior and we’ll merely have a bunch of permits laying around on the ground like unwanted grocery store coupons (EU demonstrated this one). Price them too high, and you can significantly alter your export industries and engender a whirlwind of business backlash (that will be there regardless, so it’s the first point that matters). I think this is an especially important consideration in the wake of our financial armageddon. To curtail America’s prodigal ways, it needs to reconcile its trade deficit (i.e. export a little more and import a little less). Some careful mathematics and a stroll down a fine line is in order if we hold to cap-and-trade.
To get away from the precarious efforts to price permits, I think we should just implement a carbon tax. Get a few smart people in a room, initiate a circumspect approximation of the negative externalities intrinsic to each unit of CO2 emissions, and charge the polluter accordingly. Take the new revenue and invest it in environmental protection interventions and subsidize new technology (help businesses pollute less, make solar and wind power implementable, etc.). Don’t want to pay more taxes? Then stop polluting…that changes behavior, right? Additionally, the price is stable (just like a sales tax), so any business can calculate its upcoming fiscal year liabilities based on expected emissions multiplied by per unit tax. No black magic or unexpected outcomes (like rock-bottom permit prices). And last but not least, the carbon tax has a social appeal: it gives Rush Limbaugh and his delusional acquaintances an excuse to get together again over a cup of tea.
The CDC is collaborating with the WHO to investigate reported outbreaks of the swine flu in Mexico, California and Texas. The WHO reports that in the USA, there have been 7 confirmed cases, 5 suspected cases, and no mortalities, mostly affecting young adults (influenza usually afflicts the young, old and immunocompromised). In Mexico, Influenza-like-illness (ILI) has been under surveillance since March 18, where there have been approximately 1000 reported cases, with 59 deaths in Mexico City and 3 deaths in San Luis Potosi located in central Mexico (although Mexicans have commented that the situation is far worse than depicted by authorities). The strains are sensitive to oseltamivir but resistant to amantadine and rimantadine. Symptoms of the respiratory tract infection include fever, sore throat, cough, myalgia and malaise. If the cases we have seen result in Antigenic Shift (complete change in HA and NA), there is risk for h1n1 pandemic, since we have no antibodies against the virus. In 1918, a swine flu virus transferred its HA to a human strain (HSW), leading to the Spanish Flu/H1N1 pandemic which resulted in 20 million deaths across the globe. Remember: don’t give children aspirin if they present with these symptoms (Reye’s Syndrome) and follow the CDC, WHO and USA government pandemic flu site for updates. Read the rest of this entry →
Ask your senators, via email and phone, to include the option of public health insurance in the Health Care Reform Bill. This would offer more choice, as the public plan would not cross off existing private insurers. Read Mary-Carol’s legislative action statement below:
Dear AMSA,
The Senate just returned from recess on Monday and square on the agenda is a big Health Care Reform bill that has yet to be fully written. One of the more important aspects of this reform process is over the inclusion of a “public health insurance option”. This is what it says, a plan run by the federal government (much like Medicare), that people have the option of buying much as they would buy a private insurance plan.
This public plan would, as our Legislators are describing it, exist alongside the private plans like Aetna and Blue Cross/Blue Shield. The legislation is on the Congressional drawing board right now and the public plan option is the contentious issue - many opponents are saying it should be on the Congressional chopping block. AMSA supports the creation of a single, country-wide risk pool of patients, funded from one budget, but right now, we’re not going to have any say at all unless we weigh in as this Nation’s future physician workforce with our support of the public insurance option at a minimum.We need your help to let your Senators know that you want your future patients to have the choice of a public health insurance option. Join AMSA members across the country today, Thursday April 23, to contact both of your Senators.
- Mary Carol
Will the public health insurance option take us a step closer to single payer? Perhaps so. But, the first thing congress and people at large must agree upon is the underlying principle that health is a human right. Without agreeing on this unshakeable foundation, health will still remain a commodity.
Innovative need mobile health technology is being evaluated and utilized for a variety of purposes around the globe. Two such technologically inventive devices recently garnered attention when they were awarded the Vodafone Americas Foundation Wireless Innovation Project Prize.
The CellScope team based out of the
The CelloPhone is based on technology developed by Prof. Aydogan Ozcan’s Group at UCLA. Users can load blood, urine or other bodily fluid samples into the modified mobile phone where images are captured by the phone’s digital camera and sent to a central processing location where a computer program provides a response with diagnostic information in the form of a text message. The technology relies on interpreting the “shadows” of cells which contain unique textures. The team hopes to utilize the device to help diagnose diseases such as malaria, HIV and tuberculosis and will use the prize money to carry out trials in South America, Africa and
For millions of people in developing countries, access to lifesaving antibiotics and antiretroviral drugs is fraught with economic hardship and social barriers. A whole family may give up food to buy medicines for a sick child; a teenager will drop out of school or take up dangerous work while a parent is ill. What if the medicines they sacrifice so much to obtain turn out to be ineffective — or worse, toxic?
As Stefano de Luigi reminds us in this powerful article and photo series, this is too often the heartbreaking reality. He uses his camera to capture impressions of the shadowy pharmaceutical market in Nigeria, a country that has been repeatedly hit by scandals involving counterfeit meds. But the problem is global, and its pervasiveness poorly monitored.
(Copyright Stephano de Luigi and VII Gallery)
For a comprehensive review of recent scientific and public health literature on the problem of counterfeit medicines, see S.E. Nsimba, Problems associated with substandard and counterfeit drugs in developing countries, East Afr J Public Health, Dec 2008 (PubMed ID 19374325).