Effect Measure is a forum for progressive public health discussion and argument as well as a source of public health information from around the web that interests the Editor(s)
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
Suppose someone owned and managed business premises which had recently experienced a dangerous incident. They were also carrying out work there that was generally acknowledged by the industry to be risky. But when a government official came around they misrepresented the earlier incident and publicly denied they were engaging in any risky practices. The government official wasn't too inquisitive and told them it was OK by him to use the risky technique. So they continued to do so and six of their workers died as a result along with three rescue workers. What would you say about such a business person? That perhaps someone should check to see if he was criminally liable? That's what Congressman George Miller, Chair of the House Education and Labor Committee, thinks:
The subject of a recent post, rabies, put us in mind of another rare, invariably fatal neurodegenerative disease, Creutzfeld-Jakob Disease (CJD). There is now pretty good evidence that the outbreak of CJD in Europe since the 1990s is caused by the same agent that causes Bovine Spongiform Encephalopathy (BSE), also known as mad cow disease. The incriminated transmissible material is an unconventional agent, an infectious protein (now called a prion). When a prion from a BSE case in cattle is consumed it causes a disease very like CJD in humans. Technically it is called new variant CJD (nvCJD). The BSE prion is thought to stem from feeding cattle other cattle via feed, a practice which is now outlawed. As a result BSE is decreasing in Europe, where extensive testing of cattle is done prior to letting the meat into the chain of commerce. Only a few cases of BSE have been detected in the US, where allegedly stringent controls have been instituted to prevent BSE from occurring. But only a tiny fraction of US cattle is tested and the cattle industry has strenuously resisted any calls for better coverage. You would think that an enterprising meatpacker would test their own products and market it as safe, thus gaining a competitive advantage, especially in export markets highly sensitive to the BSE problem, like Japan. You would be wrong. Not because it isn't a good idea but because the US Department of Agriculture (USDA) forbids the practice. We've discussed it three times here in the context of a Kansas company trying to test its own cattle and being told it cannot.
Let's face it. Tolerance for other religions is bad for religion. As long as people only knew about their own religion (translation: their parents' religion) they didn't question it. As soon as they became aware there were a lot of religions and theirs only one among them, then the question of why this one rather than that one raised its ugly head. Religious instruction is sometimes smuggled into public school under the guise of "comparative religion" but that will only hasten its down fall. Once people know there are not dozens but hundreds of religions, the inevitable question arises. Which one?
We talk a fair amount about intellectual property issues here. When it comes to the free exchange of scientific information already paid for by taxpayers or the rapacious use of intellectual property laws by Big Pharma to price gouge the developed world and pillage the developing world the connections to public health are clear to us. Maybe some of you thought they were a stretch but now we have agreement from an unlikely source: the Los Angeles County Board of Supervisors. Of course their take is 180 degrees in the opposite direction. For them it's infringement that's the public health and safety threat:
Last October (2007) a 46 year old Minnesota man died of rabies, the only known victim in the US last year. Rabies is a rare disease in the US because we have good veterinary services. Most animals in routine and regular contact with humans are vaccinated against the disease. But bats have become a significant wild animal reservoir and the Minnesota case was a bat case:
We seem to be doing a lot of vaccination stuff here lately. It's an obvious public health topic, one that's in the news and (in some quarters) considered controversial. I'm a strong proponent of vaccination where it makes sense (which is in most of the instances where it is used) but that doesn't mean I think it is problem free. For a public health scientist the problems are not only interesting but of practical import. Yesterday's post about fainting during vaccinations produced an unexpected comment thread from people who have at one time or another fainted during a vaccination or medical procedure, for example. The rare adverse event, even if it is one in a million or ten million, can affect public confidence in a whole vaccination program since when you are giving tens of millions of doses, even rare events are bound to occur, even though the net benefit to the public is very large compared to the tiny risk. But one issue that has been hidden, probably because many of our most effective and important vaccines are relatively recent, is our ignorance about how long they are effective. This arose recently in a multi-state mumps outbreak where it turns out most of the indigenous cases were among those previously vaccinated against the disease. Apparently the vaccine's effect had waned. This has raised some interesting questions.
Vaccination against most childhood diseases is important for the overall health of the community. I've said that many times here and most recently, along with my Sciblings, bemoaned an increasing trend to refusing vaccination. The health related reasons for refusing to be vaccinated are largely based on false information, but that doesn't mean that when millions of people are being vaccinated something untoward doesn't happen. Usually what happens is innocuous and self-limiting. The person (often an adolescent) faints. We don't know how often that happens, but a recent effort by CDC has tried to get some handle on it. It is a relatively common vaccination associated adverse event but the operative word here is "relatively." The estimated rate is only a few cases in ten million vaccinations. Occasionally a serious injury will result from a fall after a faint. Here are two case examples from the CDC study:
The AP has a story that a task force composed of medical and other experts from academia, professional groups, the military and government executive branches and agencies like the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services has been considering how to ration scarce medical resources in the event of a pandemic. Before I give you their suggested answer I want to consider the underlying problem. This may be too abstract a way for some to think about this, but it is the logical bare bones of the matter.
Mrs. R. and I visited Australia a number of years back. She was the one attending a scientific congress while I was the accompanying spouse. Quite nice, really. I enjoyed not having to work on a foreign visit. And Australia was terrific. We loved it. I was surprised at how good the food was (a baseless prejudice I had about Commonwealth Cuisine) and the people hospitable and friendly. Much like America, really. Unfortunately the Australian government is becoming too much like the US government when it comes to interfering in science:
