Wednesday, December 28, 2005

"AMERICANS LIKELY TO BECOME HUMAN GUINEA PIGS"

Read the whole article from the Center for Justice and Democracy website.

"THE DRUG INDUSTRY ALREADY BENEFITS FROM LIABILITY PROTECTION FOR PRODUCTION OF SEASONAL FLU VACCINES AND OTHER CHILDHOOD VACCINES

The Vaccine Injury Compensation Program (enacted under the Childhood Vaccine Injury Act of 1986) provides drug manufacturers protection from lawsuits arising out of injuries caused by vaccination, forcing injured victims into an administrative compensation program8 The Program covers the major childhood vaccines as well as the seasonal flu vaccine (this was added in 2004).9

* As of 2001, 75 percent of claims were denied.10
* Many of these claims are denied after long and contentious legal battles taking an average of 7 years to be resolved.11
* Attorneys are less likely to take on vaccine injury cases due to these bureaucratic and political hurdles.12
* The Fund is designed so that the Department of Health and Human Services may unilaterally tighten the restrictions on claimants. In 1995, DHHS changed the burdens of proof so drastically that claims went from being paid in one out of three cases to one out of seven.13"

----------------
"8 42 USC § 300 aa-1, table can be found on-line at http://bhpr.hrsa.gov/vicp/table.htm

9 Fact Sheet, Flu Vaccine Crisis: The Role of Liability Concerns, Office of Rep. Henry A. Waxman, Committee on Government Reform, U.S. House of Representatives, October 18, 2004.

10 Elizabeth C. Scott, 'The National Childhood Vaccine Injury Act Turns Fifteen,' 56 Food Drug L.J. 351 (2001)

11Ibid.

12 24 J. Health Pol. Pol’y & L. 82.

13 Statement of the National Vaccine Information Center Co-Founder & President, Barbara Loe Fisher, September 28, 1999, House Oversight Hearing, 'Compensating Vaccine Injury: Are Reforms Needed?'"

Update: Drug Companies Immunity For Bird Flu Drug and Vaccine Production

Read "Senate Passes Last Minute Bill Giving Drug Companies Immunity From Deaths And Adverse Reactions Caused By Vaccines And Drugs Used For Bird Flu" by Kristin Keckeisen in Crusador eAlerts (12/23/05).

I recently posted a description of the exceptional protection for industry provided by the flu pandemic provisions of the Defense Appropriations Bill. This is an update by Kristin Keckeisen I found on the Internet:

In the final hours just before adjourning for the year, the Senate last night passed the Defense Appropriations bill that contained the pandemic flu preparedness provisions, including outrageous immunity protection for drug companies.......

What passed last night as part of the defense bill is not responsible. In fact, and sadly, it even includes a shield for reckless misconduct in some cases.

Even more outrageous than the substance of these provisions, if that's possible, is how these provisions were slipped into the conference report at midnight on Sunday. After many Senators and House members had already signed the conference report, Majority Leader Frist and Speaker Hastert privately conspired with the White House to add wholly new language containing the liability protections to the conference report.......

with the help of Senate friends such as Senator Ted Kennedy, we succeeded in defeating cloture on the Defense Appropriations Conference Report.

In the end, the Frist-Hastert language survived due to the politics surrounding the must-pass nature of the defense spending bill, combined with the rush to get home for holidays.

The Christian Science Monitor provides this update:
Another provision, granting immunity from liability to manufacturers of flu vaccine, was added at the last minute to the FY 2006 Defense Appropriations bill. Senate majority leader Bill Frist, who sponsored the measure, says that "appropriate, targeted liability protections" are needed to reestablish a manufacturing base in the US for vaccines. "A pandemic will occur," he says.

After protests from citizens' groups, a previous attempt by Senator Frist to add such a provision was repealed. But last week, Frist, with the approval of House GOP leaders, added the provision back to the Defense bill.

Sen. Edward Kennedy (D) of Massachusetts dubbed the move "a massive Christmas bonus to the drug companies at the expense of nurses, firefighters, and ordinary Americans who will have to take untested vaccines and drugs and get no money for compensation if they are injured."

Sunday, December 25, 2005

"The Flu Hunter"


Read the full article by Michael Rosenwald in Smithsonian. (January 2006)

Summary:
For years, Robert Webster has been warning of a global influenza outbreak. Now governments worldwide are finally listening to him

Robert Webster is the world's preeminent expert on avian influenza. A virologist at St. Jude Children's Research Hospital in Memphis, he helped create the first widespread commercial flu vaccine decades ago. It was Webster who discovered that birds were likely responsible for past flu pandemics, including the one in Asia in 1957 that killed about two million people. Perhaps Webster's greatest contribution to science is the idea that global influenza epidemics begin when avian and human flu viruses combine to form a new strain, one that people lack the ability to fight off.

For all those reasons, Webster is in great demand as governments worldwide try to stave off a possible epidemic of influenza, the likes of which haven't been seen since the great pandemic of 1918-1919, which killed at least 40 million people. Smithsonian dispatched Michael Rosenwald to catch up with Webster and report on the scientist whom one expert has called an "international treasure."

Excerpts:

“Will the H5N1 currently circulating in Vietnam learn to transmit, reproduce, from human to human? Why hasn’t it done so already? It’s had three years to learn how, and so what’s it waiting for? Why can’t it finish the job? We hope it doesn’t.” He paused. “Is it the pig that’s missing in the story?”
(Webster's) lab at St. Jude Children’s Research Hospital in Memphis is the world’s only laboratory that studies the human-animal interface of influenza. It was Webster who discovered that birds were likely responsible for past flu pandemics, including the one in Asia in 1957 that killed about two million people.

It occurred to Webster that there was a problem. The problem was H5N1. Neither he nor any members of his staff had ever been exposed to the virus strain, meaning they did
not have any antibodies to it, meaning they had no defense against it. If they became infected, they would likely meet the same fate as the little boy who died.

They needed a vaccine. Four decades before, Webster had helped create the first widespread commercial flu vaccine. Until he came along, flu vaccines were given whole—the entire virus was inactivated and then injected. This caused numerous side effects, some of which were worse than the flu. Webster and his colleagues had the idea to break up the virus with detergents, so that only the immunity-producing particles need be injected to spur an immune response. Most standard flu shots still work like this today.

Before they went to work in Hong Kong, Webster and his colleagues created a sort of crude vaccine from a sample containing the H5N1 virus. They declined to discuss the matter in detail, but they treated the sample to inactivate the virus. Webster arranged for a pathologist in Hong Kong to drip the vaccine into his nose and the noses of his staff. In theory, an tibodies to the virus would soon form.
“Are you sure this is inactivated?” the pathologist said.
Webster pondered the question for a moment.
“Yes it is. I hope.”
And the fluid began dripping.

Saturday, December 24, 2005

"Breaking the Knowledge Acquisition Bottleneck Through Conversational Knowledge Management"

Read the paper by Christian Wagner in the Information Resoures Management Journal (IRMJ) via Knowledge Board. (January-March 2006)

"Much of today's organizational knowledge still exists outside of formal information repositories and often only in people's heads. While organizations are eager to capture this knowledge, existing acquisition methods are not up to the task. Neither traditional artificial intelligence based approaches nor more recent, less-structured knowledge management techniques have overcome the knowledge acquisition challenges. This article investigates knowledge acquisition bottlenecks and proposes the use of collaborative, conversational knowledge management to remove them. The article demonstrates the opportunity for more effective knowledge acquisition through the application of the principles of Bazaar style, open-source development. The article introduces wikis as software that enables this type of knowledge acquisition. It empirically analyzes the Wikipedia to produce evidence for the feasibility and effectiveness of the proposed approach."

Happy Holidays!


"Critics Say Flu Bill Overprotects Drug Industry"

"They say provisions added to the pandemic legislation would shield firms from liability." Read the full article by Ricardo Alonso-Zaldivar in the Los Angeles Times. (December 20, 2005)

"Bird flu preparedness legislation headed for a final vote in the Senate this week would create loopholes that critics said would allow vaccine makers to avoid legal liability even if a patient were harmed by negligence.

"Democrats and the Assn. of Trial Lawyers of America derided the provisions Monday as a gift to the drug industry. Supporters of the legal exemption said the lawyers were acting in their own self-interest, but a leading public health group also criticized the liability language......

"The liability provisions are contained in a mammoth defense spending bill that would provide $3.8 billion of President Bush's $7-billion request for pandemic preparedness.

"'Washington Republicans tucked a huge Christmas present for the drug companies into the appropriations bill in the dead of night,' said Rep. Henry A. Waxman (D-Los Angeles). 'The liability shield can be granted to any product used to prevent or treat an epidemic or a pandemic, and the [administration] gets to decide what that means.'.......

"Manufacturers of drugs designated to deal with the emergency would be shielded from lawsuits unless they had engaged in "willful misconduct." Such a threshold is so high it would protect companies that were negligent or reckless, critics said......

"Although the legislation would create a compensation program for patients injured by pandemic vaccines, it allocates no money for the fund. That would be determined according to the need in an emergency, supporters of the bill said.

"Some critics said the language was so broad that it could allow the secretary of Health and Human Services to declare an emergency for any serious health problem facing the country, such as obesity or diabetes. The bill specifies that the secretary's decision could not be challenged in any federal or state court."


"UPDATE 2-U.S. House passes $453.3 billion defense bill" (Reuters, December 22, 2005.)
"The defense spending bill also contains nearly $3.8 billion to begin preparations for a possible avian flu pandemic.

"The Bush administration had sought more than $7 billion to stockpile drugs and take other steps in case the deadly animal illness mutates in a way that makes it easily transmissible to humans.

"Rep. David Obey of Wisconsin, the senior Democrat on the House Appropriations Committee, attacked a provision that House and Senate Republican leaders inserted into the bill giving drug companies protection from lawsuits.

"Obey, who said he would support narrow protections for manufacturers of avian flu vaccines, criticized the provision he said provides 'all sorts of insulation for pharmaceutical companies, not just drugs to deal with the flu, but a far broader range of products.'

"The avian flu money would also be used to increase international surveillance of the disease and help state and local authorities in the United States prepare."


"Bush planned bill-signings next week of a massive defense bill." (Mary Dalrymple, Associated Press via the Boston Globe, December 24, 2005.)

The Defense Appropriations Law should soon be available on this website, so you can read for yourself the final version.

Friday, December 23, 2005

Evidence & Policy


A journal of research, debate and practice

"Evidence & Policy is the first peer-reviewed journal dedicated to comprehensive and critical treatment of the relationship between research evidence and the concerns of policy makers and practitioners. International in scope and interdisciplinary in focus, it addresses the needs of those who provide public services, and those who provide the research base for evaluation and development across a wide range of social and public policy issues – from social care to education, from public health to criminal justice."

This journal is relatively expensive, but provides free online access to people working in member institutions. One issue is available free online.

"China overtakes U.S. as world’s leading exporter of information technology goods"

Source: OECD

Read the full report on the OECD website.

"China overtook the United States in 2004 to become the world’s leading exporter of information and communications technology (ICT) goods such as mobile phones, laptop computers and digital cameras, according to OECD data.

"China exported USD 180 billion worth of ICT goods in 2004, compared with U.S. exports in the same category valued at USD 149 billion. In 2003, the U.S. led with exports of ICT goods worth USD 137 billion, followed by China with USD 123 billion.

"China’s share of total world trade in ICT goods, including both imports and exports, rose to USD 329 billion in 2004, up from USD 234 billion in 2003 and USD 35 billion in 1996. By comparison, the U.S. share of total world trade stood at USD 375 billion in 2004, USD 301 billion in 2003 and USD 230 billion in 1996."

Thursday, December 22, 2005

Scientific Integrity in Policy Making: Investigation of the Bush administration's abuse of science

Go to the Union of Concerned Scientists website on Scientific Integrity.

"On February 18, 2004, 62 preeminent scientists including Nobel laureates, National Medal of Science recipients, former senior advisers to administrations of both parties, numerous members of the National Academy of Sciences, and other well-known researchers released a statement titled Restoring Scientific Integrity in Policy Making. In this statement, the scientists charged the Bush administration with widespread and unprecedented 'manipulation of the process through which science enters into its decisions'

"The scientists’ statement made brief reference to specific cases that illustrate this pattern of behavior. In conjunction with the statement, the Union of Concerned Scientists (UCS) released detailed documentation backing up the scientists’ charges in its report, Scientific Integrity in Policy Making: Further investigation of the Bush administration's abuse of science.

"Regrettably, The Bush administration has continued to undermine the integrity of science in policy making seemingly unchecked. To document new incidents that surfaced since the report's release, UCS released a second report titled Scientific Integrity in Policy Making: Further investigation of the Bush administration's abuse of science. Read selected cases from the two reports."

"INDIAN SCIENCE: Booming Computer Sector Seen as a Mixed Blessing"

Read the full news article by Pallava Bagla in Science. 16 December 2005. (Subscription required.)

"India cemented its claim to leadership in information technology (IT) last week when three U.S. companies--Microsoft, Intel, and Advanced Micro Devices (AMD)--announced plans to spend nearly $6 billion on research and manufacturing here over the next few years. The economy will benefit, but some scientists are concerned that the IT bonanza could drain talent away from basic research......

"According to the National Association of Software and Service Companies (NASSCOM) in New Delhi, Indian software and services exports grew more than 34% from 2004 to 2005, earning revenues of $17.2 billion over a 12-month period......

"Although the IT sector is booming, some leaders fear that its rapid growth could hurt other areas of research. Astrophysicist Rajesh Kochhar, former director of the National Institute of Science, Technology, and Development Studies in New Delhi, says: 'There can be no doubt that information technology is acting as a brain sink.' New entrants in the Indian IT sector are paid roughly three times as much as entry-level scientists, he says. The result, he argues, is that 'highly qualified engineers are doing stupid, repetitive work.' Echoing this view, aeronautics engineer Gangan Prathap, chief of the Centre for Mathematical Modelling and Computer Simulation in Bangalore, says foreign investments like those announced this week could "seduce" Indians into becoming 'a nation of techno-coolies.' He claims that academic centers already must 'scrounge at the bottom of the barrel" for talent.'"

"U.S. COMPETITIVENESS: Summit Lists Ways--but Not Means--to Strengthen Science"

Read the full news article by Jeffrey Mervis in Science. 16 December 2005. (Subscription required.)

The National Summit on Competitiveness, a 1-day meeting hosted by the Department of Commerce, was held in Washington early in December. The website is worth visiting, with its statement and with a bibliography of recent reports on innovation.

Science reports:

"The group's series of recommendations......include more federal spending on basic research and set-asides for high-risk research, a doubling over the next 10 years of the number of undergraduates earning science and engineering degrees, changes in immigration laws to make it easier for foreign-born graduates to remain in the United States, and greater support for advanced manufacturing technologies......Participants made no attempt to rank the importance of those recommendations, for instance. 'There are no priorities for essentials, and these are all essential.'"

"The future of Japanese business: Competing through innovation"

Read the complete article from The Economist. December 14th 2005. (Subscription required.)

"Japan's style of innovation failed it in software and biotechnology in the 1990s. It might work better in robotics, aerospace and other burgeoning technologies."

"Japanese firms have not counted for much in software, the internet, biotechnology and other high-growth industries over the past decade. Japan can boast no equivalent of Microsoft, Google, Amazon or eBay. Its entire software industry has failed to make an impression on the world......Although a handful of Japanese pharmaceutical firms have developed a few profitable drugs, Japanese companies are also far behind the rest in biotechnology and medical devices. Japan's lack of success is not for want of trying. The country continues to lead the world in research and development, investing 3.2% of its GDP in R&D, compared with 2.6% in America and 2% in the European Union. Moreover, unlike western countries, where government and university labs generate lots of breakthroughs, Japan performs more of its R&D in big companies."

"Instead, the country's failure has much to do with its method of management and organisation. This won extravagant praise in the 1980s, when western writers and businessmen flocked to Japan for answers, and when the “lean” production manufacturing techniques pioneered by the likes of Toyota changed the world. The Japanese way of running companies has since fallen out of fashion, however."

"A few Japanese bankers have set up funds to promote venture capital (or at least what passes for it in Japan). The government has also converted all of Japan's national universities into public corporations, in a bid to shake up scientists' civil-service mentality and make them more flexible and innovative. New clusters and consortia are popping up all over the Japanese islands, to promote better links between university laboratories, government budgets and corporate R&D. Between 2000 and 2003 the number of start-ups created to commercialise discoveries at Japanese universities rose from 315 to 800."

"Yet to focus on the slow pace of reform in Japan is to miss an important point: that there are many ways to innovate, and no single approach is “right” for all times and technologies. Japanese companies are already very good at—indeed, lead the world in—many types of innovation. The reason they lost their edge in the 1990s is not so much because their approach to innovation was “wrong”, as because it was ill-suited to the sectors dominating that decade. The next few years could easily be different, since the battle over next-generation technologies may well be in areas that suit the Japanese far better than biotech and software ever did." (Emphasis added.)

"In biotech and software America gained a clear edge from its ability to let lots of start-ups experiment with new techniques and business models, and to commercialise ideas from university research laboratories as quickly as possible. America's other advantage is in basic scientific research. Its universities dominate rankings of the best in the world and are well integrated with government and business laboratories. In other technology-heavy sectors, however, including several that Japanese companies are betting on, the university laboratory and the entrepreneur's garage have less of an advantage over a big Japanese corporation with extensive business experience and a giant R&D budget.

"The American start-up method works very well when hundreds or thousands of potential business models might succeed—and the best way to find out which is to allow each brave or disgruntled genius to try out his own approach. Many fail, but a few succeed.

"In other industries and technologies—such as cars and electronics in the 1970s and 1980s—a better way to innovate is to learn by doing. If 100 start-ups try, all might fail before they learn anything useful or before they come up with a product or service they can sell. A big company is often better suited to such fields. Not only can it offer its innovators a more reliable source of investment capital, but it also has links to consumers, which it can use quickly to improve the next generation of whatever it is making. A big company in a new field can afford to make products with initial drawbacks, provided it learns quickly to overcome them.

"As they once did in cars and electronics, Japanese companies are today pursuing future technologies in several industries by making things first and only then pausing to think about how to improve them or put them to new uses. This leaves them at a familiar disadvantage in blue-sky research. But the idea—which has worked well enough in other industries to turn Japan into the world's second-biggest economy—is to keep getting better, eliminating costs and boosting quality, while rivals in America and Europe waste precious time at the drawing board. When Japanese companies do it right, they can innovate so quickly that they leave western competitors gasping for air."

"Get planting"

Read Peter Campbell's full review of The Secret Life of Trees: How They Live and Why They Matter by Colin Tudge in the London Review of Books. (Subscription required.)

Exceprts:

"Despite the variety of introduced species, if you confine yourself to England’s managed, temperate landscape the picture you get is very limited. Alan Mitchell’s Trees of Britain and Northern Europe, a field guide which reckons to include ‘every species and large-growing cultivar to be seen in the countryside, parks and gardens of Europe north of the Mediterranean littoral’, is a book of modest proportions. The rainforest is a different matter, as is the foggy, rain-free Californian coast, as is the Cerrado of Brazil or the eucalyptus forests in Australia; and the central theme of Colin Tudge’s The Secret Life of Trees is variety and the evolution of variety: variety in form, in adaptation, in kinds of dependence – most trees need to cohabit with soil fungi, some need insects, birds or fruit bats to pollinate them and spread their seed, some are parasitic on other trees.

"Tudge makes the British experience seem truly insular. He writes, for example, about ‘the wondrous Reserva Florestal Adolfo Ducke’, which covers a hundred square kilometres of Amazon rainforest. Two thousand times smaller than Britain, it has forty times as many native trees – 1300 species. That in itself raises a question: why are there so many more species in the tropics than in higher latitudes? Tudge goes through the theories (not all of them – there are in print, he says, about 120 recognisably distinct attempts at an explanation). He finds no clear winner but thinks two ideas are particularly cogent. First, that away from the tropics ice ages wiped the slate clean again and again, leaving tough terrain in tough climates where only the adept survive. Second, that in the tropics the pressures are biological rather than physical, and that pressure from parasites, which a species of fewer, widely spaced individuals is better able to counter, is a major reason for diversity."

"Knowledge about the ways in which growth, morphogenesis and reproduction are regulated has been advanced through studies of a few species. One, Arabidopsis thaliana, has become a model organism because it has a short life-cycle, produces abundant seed and is easy to manipulate genetically. The insight into plant life which has come from such single-species studies has begun to make sense of plant form and function at the level of the cell. This science is, to borrow the old terminology, ‘natural philosophy’. The term ‘natural history’ better fits descriptions and analyses which emphasise the variety of species, their adaptations and their interdependence in communities. The work of the ecologists, foresters, field botanists and taxonomists that Tudge draws on is of that kind."

"Tudge ends his book with a secular sermon. The modern world, he says, is governed by the idea – call it a principle – that the only measure of right policy is an increase in the volume and money-value of goods and services; that this destroys the possibility of a sustainable relationship between us and our planet; that fertile land is taken over by mechanised agriculture, to the benefit of the few; that the many, forced off the land, gather in the slums of cities which already contain half the world’s population; that burning fossil fuel to drive our industries is leading to deleterious climate change; and that our only hope lies in a new kind of politics, a democracy in which people realise where their true advantage lies and are able to prevent governments and businesses standing in the way of its achievement."

Europe must get its act together on science aid

Read Devid Dickson's editorial in SciDev.Net. (December 19, 2005)

"The European Union is still struggling to meet commitments by its member states to increase science capacity in developing countries. To achieve this, closer alignment is needed between its efforts to boost research and to alleviate global poverty."

"Resistance to Bird Flu Drug Reported"

From "Findings" in The Washington Post. (December 22, 2005)

"In a development experts called alarming, two bird flu patients in Vietnam died after developing resistance to Tamiflu, the key drug that governments are stockpiling in case of a large-scale outbreak. The experts said the deaths were disturbing because the two girls had received early and aggressive treatment with Tamiflu and had gotten the recommended doses. The new report suggests that the doses doctors now consider ideal may be too low........The study in today's New England Journal of Medicine was led by Menno de Jong of the University of Oxford."

Wednesday, December 21, 2005

"Research as Empowerment?"

Go to the Communications Initiative website for this paper.

"This 62-page report offers information based on a series of seminars organised by the Toronto Group which seek to examine evidence-based policy and practice in health and social care. Additionally it explores the issue of extending the involvement of service users in research.

"The seminars, which took place in different locations in England, covered four topics: involving service users in traditional or mainstream research; involving service users in peer review; involving people from black and minority ethnic communities in research; and emancipatory research.

"According to the report, one of the fundamental barriers to the empowerment of service users in mainstream research remains the unequal relationship between the researcher and research participants. For instance, the report describes research carried out on the subject of Britain’s black and minority ethnic communities where they are viewed as ‘objects’ of research, rather than as potential participants in the research process. The report describes another obstacle based on expectations since service users and researchers may have different ideas about the purpose of the research.

"Some of the issues described in this report center around perspective. For instance, the report suggests that white researchers may not address the questions that people from black and minority ethnic communities see as a priority. "Researchers may focus on people’s experience of using services, rather than on people’s perspectives on what they consider to be important." As a result individual’s priorities are not identified and therefore not acted upon. As a further example, the report refers to the fact that people who are seen as having power in the research-commissioning process "are not actively committed to listening to the view of service user reviewers..." According to the report, this can lead service users to feel that their views are ignored.

"The report makes note of the fact that research carried out by service users is rarely published in peer-reviewed journals and as a result does not gain recognition from other parts of the research community, or from those who judge the quality of research. According to the report, this is changing because some mainstream research funders are beginning to make the involvement of service users in research a requirement for funding."

"Global Trend: More Science, More Fraud"


Read the full article by LAWRENCE K. ALTMAN and WILLIAM J. BROAD in The New York Times. (December 20, 2005)

"Science is often said to bar dishonesty and bad research with a triple safety net. The first is peer review, in which experts advise governments about what research to finance. The second is the referee system, which has journals ask reviewers to judge if manuscripts merit publication. The last is replication, whereby independent scientists see if the work holds up.

"But a series of scientific scandals in the 1970's and 1980's challenged the scientific community's faith in these mechanisms to root out malfeasance. In response the United States has over the last two decades added extra protections, including new laws and government investigative bodies.

"And as research around the globe has increased, most without the benefit of such safeguards, so have the cases of scientific misconduct."

Tuesday, December 20, 2005

Welcom back to an old friend and colleague


Go to the People section in Science of 2 December 2005. (Subscription required.)

Francesca Grifo

Political science: Working on biodiversity issues at the U.S. Agency for International Development and the National Institutes of Health, botanical systematist Francesca Grifo learned that policymaking is often guided by factors other than peer-reviewed science. She hopes to reduce the chances of that happening as director of a new permanent program on scientific integrity at the Union of Concerned Scientists (UCS). Grifo most recently worked as a policy instructor at Columbia University and curator of the American Museum of Natural History. She came to UCS this fall to make science a stronger force in the political arena. “Just because you’re right and just because you have your data doesn’t mean science takes the day,” she says.Among the challenges she wants to tackle are inadequate protections for whistleblowers, questionable appointments to federal scientific advisory boards, and the role of science in decisionmaking. To those who label UCS as partisan and liberal, she says “we’re focusing on this Administration because that’s what’s happening now.”

"The Arab Drift Into Scientific Obscurity"

Read the full article by Faisal Sanai, Arab News, . (20 December, 2005)

"In this era of globalization, a nation’s growth within the maturity module is determined by its scientific progress. Scientific progress in turn, is measured by the nation’s overall research publication in key peer-reviewed journals. This, to put it metaphorically, is the 'Holy Grail' of the research community.....

"It appears that Arab scholars across the expanse of the Middle East have become mere patrons of development rather than the pioneers they once were.

"Our scientific community is in deep hibernation. Not since the pre-Renaissance era has there been such a dearth of medical research. There is a malaise that seems to afflict Arab academic output and it has reached epidemic proportions. And the situation is only getting worse. There is now a pressing need for this issue to be addressed before we become the victims of our own neglect."

Facts, Rhetorical Statements and Quantification

I want to use this posting to consider statements of intentionality, whether they should be considered to be factual, and how to interpret their meaning. I will try to relate the thoughts on intentionality to the theme of social and economic development, and especially to the “goals and objectives” specified for development programs and projects.

President Bush’s speech Sunday night provides an opportunity for doing so. I will try to refrain from commentary on the Iraq war itself. There is an abundance of such comment already, and by people much more worthy of attention on the subject than I. The speech, however, provides vehicle for discussing some questions important to the topic of Knowledge for Development, and thus to the theme of this blog.

President Bush stated:
Now there are only two options before our country -- victory or defeat.

Of course, a moment’s consideration reveals that there are many options before the United States with respect to Iraq – an infinite variety. Indeed, “victory” and “defeat” are not options but outcomes, and there are many possible outcomes, ranging from the more to the less desirable. Bush’s is a rhetorical statement, not a statement of fact.

And, of course, political leaders must use rhetorical statements to gather political and popular support for the policies they advocate. To try to limit politicians to statements of fact would annoy them, frustrate us, and fail ignominiously.

Social and economic development is a political issue, and politicians use rhetoric all the time in its discussion. Indeed, stakeholders in development of all kinds argue for their positions. They (appropriately) use rhetorical techniques in making their arguments. The goals and objectives specified for development projects may often be seen as statements designed to gain support for the projects, or to motivate stakeholders in implementing those projects. Yet they are often treated as statements of belief, or indeed as statements of fact.

Bush also stated:
From this office, nearly three years ago, I announced the start of military operations in Iraq. Our Coalition confronted a regime that defied United Nations Security Council Resolutions -- violated a cease-fire agreement -- sponsored terrorism -- and possessed, we believed, weapons of mass destruction. After the swift fall of Baghdad, we found mass graves filled by a dictator -- we found some capacity to restart programs to produce weapons of mass destruction -- but we did not find those weapons.

It is true that Saddam Hussein had a history of pursuing and using weapons of mass destruction. It is true that he systematically concealed those programs, and blocked the work of UN weapons inspectors. It is true that many nations believed that Saddam had weapons of mass destruction. But much of the intelligence turned out to be wrong. And as your President, I am responsible for the decision to go into Iraq.

Yet it was right to remove Saddam Hussein from power. He was given an ultimatum -- and he made his choice for war. And the result of that war was to rid the world of a murderous dictator who menaced his people, invaded his neighbors, and declared America to be his enemy. Saddam Hussein, captured and jailed, is still the same raging tyrant -- only now without a throne. His power to harm a single man, woman, or child is gone forever. And the world is better for it.

What does “victory mean? If it means prosecuting the war until its original goals are met, it is not clear how victory could be achieved. How could the United States eliminate the weapons of mass destruction from Saddam Hussein’s Iraq and stop it from sponsoring terrorism, if there were not WMDs nor sponsorship of international terrorism in the first place?

The decision to go to war in Iraq was complex. Probably more complex than could have been described in public statements. I think that an exhaustive attempt to describe the rationale for the war would have been a “poor argument”. Such a listing would not have succeeded in gaining the public support in the United States nor the acquiescence of other government which the war required. However, even if they did not describe the deliberations, the decision makers in the U.S. government must have considered the move in terms of the complex interplay of international economic and security policy – e.g. energy, Israel, stability in the Middle East, preparedness and alternative uses of U.S. military resources. Domestic policy must have been considered; it must have been concluded that economic conditions did not preclude a war, and that the administration could obtain domestic support to initiate the war.

The Bush Administration will be judged, by history and possibly in future elections, on the basis of its past decisions. But the selection of a course of action today depends on the situation today and how it is understood. How is the situation in Iraq to be improved? That decision will of course be influenced for each stakeholder by that stakeholder’s responsibility for the current situation.

So too, development programs and projects must be advanced at each moment according to the situation at that moment, and the responsibilities of the stakeholders for that situation, not on the basis of the original assumptions and plans, and certainly not to slavishly follow the original rhetoric.

Bush also stated:
America, our Coalition, and Iraqi leaders are working toward the same goal -- a democratic Iraq that can defend itself -- that will never again be a safe haven for terrorists -- and that will serve as a model of freedom for the Middle East……..I have never been more certain that America's actions in Iraq are essential to the security of our citizens, and will lay the foundation of peace for our children and grandchildren.

At one level, this statement reflects “goal structuring”. The original concerns for WMDs and terrorism were part of overriding goals for security and peace. So too, the planned removal of the Saddam Hussein government was surely always recognized to require subsequent efforts to put something in its place; subordinate goals would always have been recognized for the adequacy of that substitute governance.

At another level, the statement reflects “goal creep” – “a democratic Iraq that can defend itself” and “a model of freedom for the Middle East” may now be goals of the Bush administration, but seem unlikely to have been original goals of a President who explicitly insisted in the election of 2000 that, if elected, he would not allow U.S. military forces to engage in "nation building."

At still another level, the statement is rhetorical, intended to build support for an increasingly unpopular Bush administration and for the war effort.

Of course goals should be structured, rhetoric should be employed by politicians to gain support for their efforts, and goals should change as situations evolve, and especially as new information accrues that changes the probabilities of the nature of the situation and the outcomes to be expected from alternative actions.

It would be idiocy to conduct the war in Iraq after three years as if the situation had not changed, and as if the initial assumptions which justified the war had not been proven erroneous.

The Lesson I Draw


Development projects and programs, too, are conducted with goals and objectives based on (sometimes erroneous) assumptions, which in turn are based on incomplete (and sometimes false) information. Moreover, explicit goals and objectives may be rhetorical statements, rather than the most accurate possible statements of expected results. Often it is foolish to continue implementing these programs when the situation changes, or those assumptions are proven false. Yet, I fear, that is exactly what happens in many cases, because program monitoring and evaluation judges success or failure in terms of the original, explicit goals and objectives. In evaluating programs, do we not wish to consider first the evolution of the situation itself, and not the degree to which that evolution was predicted? Indeed, should statements of goals and objectives not be chosen to contribute most to the desired direction of that evolution?

The Role for Quantification

I was surprised to hear President Bush state, in a televised interview last week, that he had not considered explicit estimates of casualties and deaths of U.S. military in making the decision to go to war, nor explicit estimates of Iraqi casualties or deaths from the action nor from the dislocations that would inevitably follow the invasion. Perhaps the considerations were implicit; there must surely be levels of casualties that would have been considered so great as to foreclose the possibility of war. Surely the possibilities of these levels actually occurring must have been considered too distant to change the decision to go to war.

In postings on this blog, I have suggested that the timing and body counts from the next flu pandemic are not amenable to statistical estimates, but are really uncertain. History provides only some ideas of what might happen, and how likely worst case scenarios might be. Equally, we can not provide good estimates on the effects of alternative actions in averting the disease, disruption and death from a future flu pandemic. Yet knowing something about the numbers is important. Knowing that 50 million deaths could occur from a pandemic flu requires some action, and knowing that the probability that such a pandemic will evolve from the current A/H5N1 flu is increasing lends urgency to such action. Knowing that such a pandemic is quite unlikely, and knowing that tens of millions die per year from other preventable causes suggests limits to the resources we devote to flu.

Quantification is important. I understand that quantitative models of battlefield casualties are now quite robust and reasonably accurate; they should have been (and probably were) used in the run up to the Iraq invasion. In many cases such as that of a flu pandemic, however, the parameter values for the available models are guesstimates rather than scientific based estimates. Even so, such models can be useful. Their real utility requires that decision makers have deep understanding to inform the confidence to place in the projections and the reliance to place upon them.

In the case of Iraq, the decision to invade changed everything – not only in Iraq, but in the Middle East and the United States. To go back to a metaphor used in the days of the Raj, it was a critical move in the great game. I can not imagine any but the most qualitative estimates being made of the effects of the move on the evolution of political systems in the Middle East, nor on the Israeli-Arab peace process. But of course, such qualitative estimates should have been and must have been made.

Quantification has become increasingly important in development circles in recent decades. This is perhaps a legacy of the computer age, or of Robert McNamara, or of the evolution of management processes in our time. But too often, quantification has become a ritual, followed by people who really don’t understand the implications of the methods and numbers that they use. Both qualitative and quantitative methods are important in planning moves in “the great game” of development. Neither is a magical device for attaining truth.

Monday, December 19, 2005

Customs Agents Seize Counterfeit Bird Flu Drug

Read the full article from the Associated Press in the Washington Post. (December 19, 2005)

Since the first package was intercepted on November 26, 2005, customs agents have seized 51 packages, each containing as many as 50 counterfeit capsules labeled generic Tamiflu.

"Lives Lost As Vaccine Programs Face Delays: Efforts to Get Medicine To Poor Children Falter"

Read the full article by Justin Gillis in the Washington Post. (December 19, 2005)

"Companies have developed two vaccines that theoretically could save the lives of several million children over the next decade, but efforts to get them to the poor countries that need them most are lagging.

"One vaccine, which protects against a life-threatening form of pneumonia, has been available to children in the United States for five years and has had a dramatic impact on disease here. The other, a vaccine that protects against a deadly form of diarrhea, is poised for a rollout soon among middle-income countries in Latin America.........

"The efforts have faltered amid a dizzying array of snafus, misjudgments and business difficulties. One company cannot produce enough vaccine, and studies needed to support widespread use of another have been slowed by behind-the-scenes squabbling. The problems have proved so vexing that the vaccines are expected to take an additional three to five years to reach the poorest villages."

The Diseases

Rotavirus

* Is an intestinal germ that is, worldwide, the most important cause of severe diarrhea in early childhood.

* Causes many hospitalizations but few deaths in wealthy countries.

* Is estimated to kill 440,000 every year, mostly young children in poor countries.

Pneumoccus

* Is a germ that can cause pneumonia, ear infection and brain inflammation, especially in young children and people with weakened immunity.

* Kills people in wealthy countries but disease rates are falling due to a vaccine.

* Has a vaccine not widely used in poor countries.

* Kills an estimated 1.6 million people every year; nearly half are young children.

SOURCES: Centers for Disease Control and Prevention, World Health Organization via the Washington Post

Sunday, December 18, 2005

The State of the World's Children 2006

UNICEF photo

Go to UNICEF's website for the report.

From the Executive Summary:

"Exclusion acts against children in all countries, societies and communities. At the national level, the root causes of exclusion are poverty, weak governance, armed conflict and HIV/AIDS. Statistical analyses of key MDG (Millennium Development Goals) indicators related to child health and education show a widening gap between children growing up in countries with the lowest level of development, torn by strife, underserved by weak governments or ravaged by HIV/AIDS and their peers in the rest of the developing world. These factors not only jeopardize these children's chances of benefiting from the Millennium agenda, they also increase the risk that they will miss out on their childhood and face continued exclusion in adulthood......

"Swift and decisive action (is required) in four key areas:
* Poverty and inequality. Adjusting poverty-reduction strategies and expanding budgets or reallocating resources to social investment would assist millions of children in the poorest countries and communities.
* Armed conflict and 'fragile' States. The international community must seek to prevent and resolve armed conflict and engage with countries with weak policy/institutional framework to protect children and women and provide essential services. Emergency responses for children caught up in conflict should include services for education, child protection and the prevention of HIV transmission.
* HIV/AIDS and children. Greater attention should be given to the impact of HIV/AIDS on children and adolescents and to ways of protecting them from both infection and exclusion. The Global Campaign on Children and HIV/AIDS will play a significant role in this regard.
* Discrimination. Governments and societies must openly confront discrimination, introduce and enforce legislation prohibiting it and implement initiatives to address exclusion faced by women and girls, ethnic and indigenous groups and the disable.
"At the extremes, children can become invisible, in effect disappearing from view within their families, communities and societies and to governments, donors, civil society, the media, the private sector and even other children. For millions of children, the main cause of their invisibility is violations of their right to protection.......

"Our commitments to children demand that every effort be made to reach them. But how can we reach those children living in the shadows? How can we ensure their inclusion in essential services and their visibility by protecting them from harm, abuse and violence and encouraging their participation in society? Three conclusions emerge:
* Understanding the plight of excluded and invisible children and the factors behind their marginalization, and then focusing initiatives on these children, must form an integral part of national strategies on child rights and development.
* The root causes of exclusion and the factors making children invisible must be addressed. Even well funded, well targeted initiatives for disadvantaged families and children risk failure if the overall conditions that foster poverty, armed conflict, weak governance, the uncontained spread of HIV/AIDS and discrimination persist.
* All elements of society must recommit to their responsibilities to children, including the creation of a strong protective environment.
"Governments bear the primary responsibility for reaching out to excluded and invisible children and need to step up their efforts in four key areas:
* Research: Strong research is essential to effective programming, but reliable data on these children is currently in short supply.
* Legislation: National legislation must match international commitments to children. Legislation that entrenches discrimination must be amended or abolished.
* Financing and capacity-building: Legislation and research on excluded and invisible children must be complemented by child-focused budgets and institution-building.
* Programmes: Service reform to remove entry barriers to essential services for excluded children is urgently required in many countries and communities. Packaging services can increase access, as can the use of satellite and mobile services for children in remote or deprived locations.
"Other actors also have a role to play. Donors and international organizations must create an enabling environment through bold and well conceived policies on aid, trade and debt relief. Civil society must acknowledge its responsibilities to children and be part of the solution. The private sector must adopt ethical corporate practices that ensure that children are never exploited. The media can become a vehicle for empowerment by providing people with accurate information and by challenging attitudes, prejudices and practices that harm children. Finally, children themselves can play an active part in their own protection and that of their peers."

Mooney "addresses a vitally important topic and gets it basically right."

Read the full review by JOHN HORGAN of The Republican War on Science in the December 18, 2005 New York Times. (free registration required)

(Chris) "Mooney charges George Bush and other conservative Republicans with 'science abuse,' which he defines as 'any attempt to inappropriately undermine, alter or otherwise interfere with the scientific process, or scientific conclusions, for political or ideological reasons.' Science abuse is not an exclusively right-wing sin, Mooney acknowledges. He condemns Greenpeace for exaggerating the risks of genetically modified 'Frankenfoods,' animal-rights groups for dismissing the medical benefits of research on animals and John Kerry for overstating the potential of stem cells during his presidential run.

"In 'politicized fights involving science, it is rare to find liberals entirely innocent of abuses,' Mooney asserts. 'But they are almost never as guilty as the Right.' By 'the Right,' Mooney means the powerful alliance of conservative Christians - who seek to influence policies on abortion, stem cells, sexual conduct and the teaching of evolution - and advocates of free enterprise who attempt to minimize regulations that cut into corporate profits. The champion of both groups - and the chief villain of Mooney's book - is President Bush, whom Mooney accuses of having 'politicized science to an unprecedented degree.'"

"Agreement Reached at Trade Talks"

Read the full article by KEITH BRADSHER in the New York Times (free registration required).

­"The world’s leading trading nations reached an agreement here on Sunday evening resolving a series of narrow but troublesome issues that have blocked a global trade agreement for the last three years."

The article goes on to enumerate the key elements of the agreement.

"WTO Reaches Agreement on Cuts in Agriculture, Cotton Subsidies"

Bloomberg.com just published a story with the following opening paragraphs:
The 149 members of the World Trade Organization approved a proposal aimed at steering global trade negotiations toward a deal on cutting tariffs and agriculture subsidies by the end of next year.

The agreement outlines plans for the U.S. and European Union to scale back their farm subsidies and open their markets to more products from the world's poorest nations in a bid to prevent a collapse in global trade talks. The deal is a first step as negotiators try to reach a new WTO deal next year......

The EU said it would scrap export payments for farm goods by 2013 and the U.S., under pressure from four West African nations, agreed to expedite deep cuts in payments to cotton growers. Both said they would allow in duty-free almost all the textiles, toys and sneakers that 32 of the world's poorest countries can send them. (emphasis added)

This is good news, but perhaps not as good as we might have thought. Yesterday, the Washington Post published an article by Paul Blustein titled, "World Bank Reconsiders Trade's Benefits to Poor". The article states:
The bank estimated three years ago that freeing international trade of all barriers and subsidies would lift 320 million people above the $2 a day poverty line by 2015. Now, however, bank economists project the figure at between 66 million and 95 million people. And even that assumes the WTO negotiators would completely abolish tariffs, quotas and other obstacles to commerce -- a fanciful scenario, calculated only to show what a maximum deal would produce.

Assuming a more plausible outcome in which the WTO members agree to some deep cuts in tariffs and subsidies while stopping short of pure free trade, the reduction in the number of people below the $2-a-day line by 2015 would be only about 6.2 million to 12.1 million people, the bank now reckons. That is less than 1 percent of the people living below the line.

To assist developing countries prepare for negotiating multilateral trade reform under the Doha Development Agenda, the World Bank put up a good website. Empirical analysis of the effects of possible Doha trade reform scenarios appear in two new books produced by the World Bank:
* Agricultural trade reform and the Doha development agenda, and
* Poverty Impacts of a WTO Agreement

These are in addition to the World Bank's Trade website which provides an entry to its overall work on trade and development.

Saturday, December 17, 2005

"Still, a Wounded Military"

The following is from Foreign Policy, "The Top 10 Stories You Missed in 2005"
In last year’s list, we pointed out that the health of the U.S. military was in serious decline. At 7 to 1, the ratio of wounded to dead in Iraq was the highest of any conflict in recent memory, including Vietnam, where the ratio was 3 to 1. A year later, the story is worse—and still largely ignored. In 2005, the most common number cited regarding the war in Iraq was the more than 2,100 U.S. soldiers that have died. When the number of wounded was mentioned, the Pentagon figure of more than 15,500 U.S. troops, or the Army Medical Department’s total of 20,748 medical evacuations, was usually rolled out. Today, the wounded-to-dead ratio remains near 7 to 1 by this official count. But a Department of Veterans Affairs (VA) report released in October tells a bigger story. Its data shows that 119,247 veterans of operations in Iraq and Afghanistan have sought VA healthcare. Of those, 46,450 were diagnosed primarily with musculoskeletal problems, such as joint ailments and back disorders. More than 36,800 veterans, or 31 percent of those the VA cared for, were treated primarily for mental disorders. Not even the VA had anticipated the number of soldiers they would be asked to help. In June, the agency told lawmakers that it had underestimated the the number of Iraq and Afghanistan veterans, and required $1 billion in emergency funding.

One hopes that an important reason that the wounded to killed ratio is high is that our troops are surviving things that would have killed in the past. Still, I am concerned that so few citizens have knowledge of the real cost of the war to the U.S. military. Perhaps more worrying is the lack of knowledge of the public about the real cost in lives lost to Iraqis of the war -- those killed by violence, and those who die of poverty because the economy is in shambles, or who die due to the failures of an overstressed public health system in the country.

"International migration, remittances, and the brain drain"


Go to the World Bank webpage with links to the book's chapters.

" Knowledge of the economic effects of migration, especially its impact on economic development, is rather limited. In order to expand knowledge on migration, and identify policies and reforms that would lead to superior development outcomes, this volume presents the results of a first set of studies carried out on the subject. Current demographic trends in both developed and developing countries are pointing toward significant, potential economic gains from migration. The labor forces in many developed countries are expected to peak around 2010, and decline by around 5 percent in the following two decades, accompanied by a rapid increase in dependency ratios. Conversely, the labor forces in many developing countries are expanding rapidly, resulting in declines in dependency ratios. This imbalance is likely to create strong demand for workers in developed countries ' labor markets, especially for numerous service sectors that can only be supplied locally. There are large north-south wage gaps, however, especially for unskilled and semiskilled labor. Part 1 of this book, Migration and Remittances, examines the determinants of migration, and the impact of migration and remittances on various development indicators, and measures of welfare. Among these are poverty and inequality; investments in education, health, housing and other productive activities; entrepreneurship; and child labor and education. It focuses on different source countries, use data collected via different methodologies, and employ different econometric tools. Their results, however, are surprisingly consistent. Part 2, Brain Drain, Brain Gain, Brain Waste, focuses on issues related to the migration of skilled workers, that is, the brain drain. It presents the most extensive database on bilateral skilled migration to date, and also examines a number of issues associated with the brain drain, that have not been emphasized in the literature so far, uncovers a number of interesting and unexpected patterns, and, provides answers to some of the debates. This volume deals essentially with economically motivated south-north migration, whose principal cause is, in most cases, the difference in (the present value of) expected real wages, adjusted for migration costs."

Download a PDF file with the entire 292 page book.

Friday, December 16, 2005

"What do bibliometric indicators tell us about world scientific output?"

Read the full issue of the Bulletin.

"Bibliometric indicators discussed in this bulletin show that the distribution of scientific production around the world is changing: developed countries’ share of world scientific publications has declined over the last 20 years. Some developing regions are increasing their production in this field (Latin America, Asia) but others are not (Africa)."


This issue of the UNESCO Institute of Statistics (UIS) Bulletin on Science and Technology Statistics presents a bibliometric analysis of 20 years of world scientific production (1981-2000), with a particular emphasis on developing countries. UIS Bulletin on Science and Technology Statistics, Issue No. 2, September 2005. (PDF, 6 pages.)

Bolton at the United Nations

Read "The Arsonist" By Mark Leon Goldberg in the January 2006 issue of The American Prospect Online Edition. (Published December 14, 2005.)

"In his ?rst six months at the UN, John Bolton has offended allies, blocked crucial negotiations, undermined the Secretary of State -- and harmed U.S. interests. We expected bad; we didn’t expect this bad."

Bolton was the man most responsible for the complexity of the negotiations at the mid-September 2005 United Nations World Summit. "A month earlier, the newly minted, recess-appointed U.S. ambassador had sent negotiations into a tailspin when he submitted some 750 alterations to a 39-page text known as the “summit outcomes” document. Bolton’s most eye-popping suggestion at this summit, billed as a renewal of the UN’s 5-year-old pledge to help poor countries, was that all 14 references in the document to the anti-poverty Millennium Development Goals (MDGs) be deleted......

"The Prospect has learned that, in the end, it took (U.S. Secretary of State Condoleezza) Rice’s personal intervention to set things right. On September 5 she participated in a conference call with UN Secretary-General Ko? Annan and British Foreign Minister Jack Straw on the subject of UN reform. The next day, Bolton sent a letter to his UN counterparts relenting on the issue. Finally, to put all lingering questions about U.S. support of the MDGs to rest, President Bush himself stated America’s ?rm commitment to them in his September 14 speech to the UN General Assembly.......

"By December, a looming crisis over the UN budget was testing Bolton and Rice’s relationship once again. At the time of this writing, the United Nations was in chaos. Ko? Annan had just canceled a trip to Asia to oversee negotiations over the UN’s biennium budget, which was being derailed by an American threat to withhold support for the UN’s two-year operating budget until a number of management reforms are passed. With a December 31 deadline looming, Bolton proposed that the world body adopt a three- or four-month interim budget -- just enough time to force other member states to accept the reforms.

"These reforms are backed by Europe, Canada, Australia, New Zealand, Japan, and the secretary-general himself. Yet Bolton’s strong-arm tactics led their representatives to warn that his proposal would starve the United Nations and disrupt other important UN business like peacekeeping operations.

"The rumor mill at the Vienna CafĂ© (in the basement of the UN building in New York) has suggested that Bolton must have bypassed Rice and received support for holding the UN budget hostage from the president himself -- a view widely held as the truth among UN diplomats. Regardless of the accuracy of this rumor, Bolton’s move is paradigmatic of his self-defeating approach to the UN: Instead of banding together with powerful allies, he alienates them. And in doing so he empowers adversaries like Iran, Venezuela, Cuba, and other spoilers content with a UN that is tied in knots. Critics feared that Bolton’s tenure would be problematic for American interests. The evidence suggests it’s been even worse."

Thursday, December 15, 2005

Trust for America's Health Flu Warnings

Go to the Trust for America's Health webpage on a possible flu pandemic.

A few days ago there was a large add in the Washington Post with the headline:
How Bad will the pandemic flu be? As bad as 500 Katrinas.

The add is apparently based on a report published on the Trust for America's Health website titled A Killer Flu?. That report contains numbers describing the potential impact on the United States of a flu pandemic;
Number of deaths: 541,433 (low death rate: 180,478; high death rate 1,082,866)
Number of hospitalizations: 2,358,089 (low severity/hospitalizations 786,032; high severity/hospitalizations: 4,716,192)
Number of cases: 66,914,573
500,000 deaths would indeed be 500 times the death toll of Katrina!

The figures are based on a guess by the World Health Organization "that an avian flu epidemic could impact 25 percent of countriesÂ? populations." Data from the Hong Kong flu epidemic of 1968-69 was apparently available describing the percentage of the persons thought to be infected who were hospitalized for flu and who died of flu. The Hong Kong flu epidemic hospitalization and death rates were then multiplied by three to get the "estimates" given above.

The important point is that these are guesses. Their epidemiological backing is more apparent than real. The portion of the population that will get sick with a future flu is of course not known, although -- as we all know -- a lot of people do get the flu each year. However, the U.S. Government pandemic flu website reports:
# 1957 influenza pandemic caused at least 70,000 U.S. deaths and 1-2 million deaths worldwide
# 1968 influenza pandemic caused about 34,000 U.S. deaths and 700,000 deaths worldwide

Thus the numbers of U.S. deaths of the 1957 and 1968 pandemics are far below even the lower value included in A Killer Flu?.

Perhaps some deconstruction is required. The add was posted by the Working Group on Pandemic Influenza Preparedness. It consists of:
# American College of Occupational and Environmental Medicine
# American Lung Association
# American Public Health Association
# Association for Professionals in Infection Control and Epidemiology
# Association of Public Health Laboratories
# Campaign for Public Health
# Center for Biosecurity of the University of Pittsburgh Medical Center
# Foundation for Environmental Security and Sustainability
# Infectious Diseases Society of America
# Service Employees International Union
# The Federation of American Scientists
# Trust for America's Health

The websites given for the add were those of the Trust for America's Health and The Association of Professionals in Infection Control and Epidemiology (APIC).

The Trust website lists a very distinguished Board of Directors and Advisory Council including former high ranking political officials and leaders of schools of public health. Its budget tops US$2 million per year, mostly from foundation grants,

APIC is a professional society serving infection control professionals, including physicians, nurses, and epidemiologists. Its efforts seem most focused on the control of infections occurring in health care facilities.

I have no doubt that all the organizations forming the Working Group are vitally concerned with improving health. They are all oriented toward the domestic health issues in the United States. And they would all seem to share an interest in increased government funding to prepare to ameliorate the effect of a global flu pandemic on the population of the United States. Note the following from a statement of purpose by the Working Group:
It is clear that that the revised pandemic flu preparedness plan issued by DHHS reflects the professional judgment of leading health and scientific experts. Our concern is that that AdministrationÂ?s budget request does not provide sufficient resources to assure nationwide implementation of all aspects of the plan, including state and local public health preparedness efforts, hospital surge capacity and related priorities, and the U.S. obligation to support international efforts to identify and contain a flu pandemic overseas.

While I do not doubt the sincerity of the opinion expressed, it seems likely that the organizations in the Working Group (and their members) would benefit from an increase in government funding of flu prevention efforts.

We don't know whether there will be a flu pandemic. If there is one, we don't know how many people will get sick from the flu, nor how severly ill they will be. In the last century, only the Spanish flu pandemic of 1918 killed as many as 500,000 people in (the much less populated) United States. The damage done by the 1957 and 1968 pandemics was terrible, but their damage was much less than that of 1918. The numbers published by the Working Group seem well tailored to getting the government to increase funding for flu preparedness. Soo too does their publication in a large add taken out in the nation's capital's most prominentnt newspaper. But those numbers must be understood as guesses, not conservative estimates based on strong scientific evidence.

We simply don't know if there is one chance in a hundred that 500,000 people will die in this country of a flu pandemic in the next few years, or one chance in a thousand, or even one in ten thousand! The decision of how much to spend on pandemic flu prevention is clearly a political one, and one that will be made under conditions of uncertainty.

Books About the History of Flu Epidemics

I attended a book discussion meeting last night about John Barry's The Great Influenza: The Epic Story of the Deadliest Plague in History. During the discussion, the following books were also recommended.
Flu: The Story Of The Great Influenza Pandemic by Gina Kolata
America's Forgotten Pandemic: The Influenza of 1918 by Alfred W. Crosby
The Devil's Flu : The World's Deadliest Influenza Epidemic and the Scientific Hunt for the Virus That Caused It by Pete Davies
The Monster at Our Door: The Global Threat of Avian Flu by Mike Davis

I have previously recommended The Swine Flu Affair: Decision-making on a Slippery Disease by Richard E. Neustadt and Harvey V. Fineberg.

I guess the theme of this posting is that history is sometimes a guide for future action, and the history of the flu is heavily documented. I would note that there is a "fallacy of availability" in decision making. We should not plan for the future assuming that the most easily recalled event is the most probable event to be repeated in the future. The 1918 flu pandemic was the worst in recorded history, and is not likely to be repeated. While many experts agree that a flu pandemic will occur in the future, and indeed within a time frame more likely to be counted in years than in decades, that pandemic may be more like the lesser flu pandemics of the last three centuries.

Developed nations are likely to take effective steps to limit the effects of a pandemic on their citizens. Medical care has advanced enormously since 1918, and the lethality of flu is likely to be greatly reduced for those who can benefit from modern medicine. Unfortunately, most of the world's people are not so lucky, and if a pandemic rages in the poor countries of Asia, Africa, and Latin America, modern transportation systems will probably assure that it reaches the richer nations of the world as well.

Of course, preparation for a pandemic is appropriate. Even one chance in a hundred of a catastrophe killing tens of millions of people demands serious public health efforts. The question is how much preparation, and how urgently. As I have pointed out before, many prudent measures are essentially without cost -- their benefits even in the absence of a pandemic exceed their costs. Such measures would include improving epidemiological surveillance systems, development of improved vaccine production technology, improved vaccines for avian flu, creating stocks of vaccines (when they are available) and antiviral drugs, improving poultry raising techniques to help farmers avoid danger to their flocks, and seeking to assure that medical care facilities are adequate to meet emergency needs.

Perhaps some of the simplest approaches are among the most important. Thus I would stress public education about hand washing, the need to avoid contact with (and eating) sick animals, and the importance of reducing contacts of and with people with the flu.

It has been estimated that 17 million people die a year because they are too poor to live. They, there families and their countries can't come up with the resources for even simple, life-saving treatments. Some 9,000 people die each day of AIDS, while only a small fraction of AIDS patients receive antiviral medication. The world has to balance spending money on a possible flu pandemic against spending to save lives that otherwise would surely be lost to diarrhea, other respiratory infections, or malaria. Indeed, it costs so little to save a life from these diseases of poverty that investments in flu preparedness would have to be very cost-effective to be economically justified.

Recall that two of the three pandemics that actually did occur in the 20th century were an order of magnitude less lethal than the Spanish flu. Reducing a death toll to a half million people, as compared with the one million who might otherwise die sounds very important and useful, until one realizes that the US$7.1 billion flu initiative announced by the White House could save millions of lives if applied effectively to the diseases of poverty.

For example, the Copenhagen consensus last year reported:
Combating HIV/AIDS should be at the top of the world's priority list. That is the recommendation from the Copenhagen Consensus 2004 expert panel of world-leading economists. About 28 million cases could be prevented by 2010. The cost would be $27 billion, with benefits almost forty times as high.
Prorating, Bush's flu initiative, if used against AIDS in developing nations, could avert seven million cases (1/4th of the full initiative), and thus seven million deaths, most of people in the prime of life.

I suppose, however, that this prescription is pretty bloodless. Perhaps one should read not only the formal histories, but fiction that conveys the human dimension of the tragedy of the 1918 flu might help. Great writers have produced such fiction. Katherine Anne Porter's novela, Pale Horse, Pale Rider, describes her own experience with the 1918 flu. So too, Thomas Wolfe's Look Homeward Angel contains a chapter based on the death of Wolfe's brother from the flu in 1918.

Wednesday, December 14, 2005

Intermittent Preventative Treatment (IPT) Against Malaria

Read the full news story by Gretchen Vogel in Science. (Science 9 December 2005: Vol. 310. no. 5754, pp. 1606 - 1607. Subscription necessary.)

"Evidence so far suggests that this simple and inexpensive treatment, called IPT for intermittent preventative treatment, may significantly slash the disease burden in young children. Nearly 1 million children die each year of the disease.....

"In an effort to weigh the costs and benefits as quickly as possible, researchers in 2003 formed the IPTi consortium. (The 'i' is for infants.) The group, which includes WHO, UNICEF, and scientists from 14 institutions in 11 countries, received $28 million in funding from the Bill and Melinda Gates Foundation......

"The first data on IPT in infants--which helped inspire the formation of the consortium--were remarkable. In 2001, Schellenberg and his colleagues reported that in a study of 700 babies in Tanzania, IPTi cut rates of clinical malaria by almost 60% compared with rates in infants who received a placebo. Another Tanzanian study in 2003 showed that IPTi reduced malarial fevers by 65% in the first year of life.

"But more recent studies suggest that such dramatic results can't be expected everywhere. In a trial of nearly 1500 infants in Ghana, described in October in the British Medical Journal, treatment cut malaria episodes by just 25% compared to a placebo. Hospital admissions for anemia, one of the most dangerous malaria complications, were 35% lower in the treatment group......

"At the site in Ghana, the disease is transmitted during the 6-month rainy season, when residents face about 10 times the rate of infective mosquito bites as faced by those in the Tanzanian study. Greenwood notes that for a subset of Ghanan babies who received their first two doses during the rainy season, results were nearly as good as those in Tanzania; it reduced clinical cases of malaria by 52% and anemia by 72%.

"But mosquito bite rates and differing seasons of infection can't explain all the differences seen in IPTi trials. Results from a trial in Mozambique, first reported last month in Yaounde, 'are not as exciting as we'd hoped for,' admits Andrea Egan of the University of Barcelona in Spain, who coordinates the IPTi consortium. A study of 1500 infants, also living in an area of moderate year-round transmission, showed a 22% reduction in clinical malaria rates compared to rates in babies who received a placebo but no difference in anemia rates."

I have always been told that the most likely strategy to be effective against malaria is a mixed strategy, combining a wide variety of measures. Even if a malaria vaccine is developed, it will probably not be a "silver bullet" which alone can erradicate the disease. A mixed strategy will probably still be required. IPT may well be an important tactic to be included in future strategies.

Tuesday, December 13, 2005

"FluMist Excels In Key Trial, Maker Says"

Read the full article by Michael Rosenwald and Justin Gillis in The Washington Post of December 12, 2005.

A new version of its nasal-spray influenza vaccine had proved superior for young children to the standard flu shot in a large global test, according to its maker, MedImmune Inc. In a test of 8,492 children in 16 countries, the standard injected vaccine was compared with a new version of a vaccine (FluMist), which is delivered as two puffs of mist in the nose. Only 3.9 percent of children receiving FluMist got the flu, versus 8.6 percent of those who received standard flu shots, a 55 percent drop. This is the third, and by far the largest, study to show superiority for FluMist.

"Several hurdles remain for FluMist, most notably whether the Food and Drug Administration will even approve the product for children under 5 and, if so, whether the agency will let the company claim superiority over flu shots. The study confirmed previous findings that FluMist poses a slight risk of precipitating wheezing episodes among some children........

"While FluMist is intended mainly for use against seasonal flu, a version could be developed rapidly for a more dangerous strain. Because it is a live vaccine that induces immunity by reproducing in the body, it would most likely be effective with one low dose, whereas studies suggest an injected vaccine would require two large doses a month apart.

"In principle, the nasal vaccine could offer crucial advantages in a pandemic, allowing authorities to make many more doses and protect many more people in a given period."

Monday, December 12, 2005

The Jhai PC and Communication System

Go to the Jhai Computer website.

The Jhai PC and Communication System seeks to respond to expressed needs of poor people for telecommunications, business opportunities, and enhanced education. Jhai's business systems and way of doing development are seen as working together with new solid-state, low-wattage computers. The Jhai PC can be powered by any power source and uses a high-bandwidth wireless network. The Jhai Foundation reports that people from 80 countries have contacted its staff, and that the Foundation is moving forward with a "Proof of Concept". The system is designed for: "micro-lending accounting and accountability, microbusiness, small business, human rights, disaster relief, agricultural extension, remote health clinic communication and business functions, telemedicine, e-learning, distance learning, curriculum enhancement, vocational education, disabled special needs, technical education, women's empowerment, coffee and other agricultural co-operatives, e-government, human network building, and ecological protection."

Lee Thorn, the Chair of the Jhai Foundation recently wrote:
The Center for Development of Advanced Computing (government of India) in cooperation with Jhai, is planning to develop and engineer a PC for India that can be produced in large volume, along the broad lines of the Jhai PC, with a target selling price of $200, including Operating System and basic application software suite in English and Indian languages. The turn-around is quite short. Mission 2007, of which Jhai is a member, has garnered the support of the Indian government, the private sector, professional organizations and civil society organizations to undertake an information and communication technology (ICT) roll out that will positively effect the economic well-being of people in 600,000 villages. MS Swaminathan Research Foundation and Datamation Foundation Trust with Jhai's help, will test the advanced socio-economic development systems of these two world famous ICT and development organizations and the new Indian PC in early 2006 to demonstrate appropriate training, connectivity choice, content decision-making, capacity building and coordination services that can used as one template for Mission 2007 efforts as it
>develops Knowledge Centres country-wide.

Wednesday, December 07, 2005

The Avian Flu

Read the full article by Canice Nolan in Bridges, an online magazine published by the Austrian Embassy in Washington's Office of Science & Technology.

"At the national level, governments around the world are drafting preparedness plans for use at national down to local levels. Currently in Europe, 49 out of 52 governments have completed plans, and the US published its plan in early November. These should be based on international guidelines (of the WHO, FAO, and OIE) where possible and tailored for national needs. It is the European Commission’s view that there should be country-ownership of these plans if they are to work.

"At the international level, the (European) commission fully supports the work of the three most involved international organizations – the WHO, the FAO, and the OIE. Indeed, these organizations have been working on avian flu for decades and on a possible pandemic for many years. Much has already been done to provide advice and support to affected regions. Much more could be done, but it is often the case that the technical experts are limited by resources.

"To this end we can only commend the organization by the US of a meeting of the International Partnership for (or is it against?) Avian and Pandemic Influenza last September. This effectively raised the political profile of this topic around the world. It was followed by International Ministerial meetings in Canada, Europe, and Asia.

"Early in November, it was the subject of a major meeting in Geneva, convened by the WHO, FAO, OIE, and the World Bank. This meeting brought many sectors together at a high level to discuss global and national response strategies against avian flu and action plans as well as country needs assessments and financing gaps. It will be followed by a ministerial donors pledging conference in Beijing in mid-January 2006, co-sponsored by the Government of China, the European Commission, and the World Bank. The international donors’ community will be invited to pledge support to national action plans of least developed countries affected or at risk of Avian Influenza. The principle of aid effectiveness requiring donors’ harmonization and alignment (Paris Declaration – OECD-DAC) was recognized in Geneva. The Beijing conference will further examine the possibility of establishing common joint financing mechanisms."

WTO Members OK amendment to make health flexibility permanent

WTO members on 6 December 2005 approved changes to the intellectual property agreement making permanent a decision on patents and public health originally adopted in 2003. That waiver made it easier for poorer countries to obtain cheaper generic versions of patented medicines by setting aside a provision of the TRIPS Agreement that could hinder exports of pharmaceuticals manufactured under compulsory licences to countries that are unable to produce them. This provision will now be formally built into the TRIPS Agreement when two thirds of the WTO’s members have ratified the change. The members have set themselves until 1 December 2007 to do this. The waiver remains in force until then. The webpage links to a:
> Press release;
> Text of the decision (Draft text — final versions are unchanged and will be available soon)
> Chair's statement and Corrigendum.