September 2005 Archives

There is exciting news in emergency medicine today that has apparently just been released by Boston Children's Hospital. The news tickles baseball fans too, especially Red Sox fans. It seems that emergency room visits decrease during riveting baseball games and increase during not so interesting games. According to the buzz, as many as 15% more people show up in the emergency departments of hospitals during boring games and 15% fewer people show up during riveting games. So says all the news. Let's have a closer look by going directly to the journal; first- where and when was the research published?

• The Boston Globe reports that the news comes from "a study published Monday in the Annals of Emergency Medicine.
• Other sources report a journal name that is strikingly similar but different. Both the New England News and Eyewitness News say; "The study appears in today's edition of the journal Annals of Emergency Room Medicine." (too much "ER"?)
• Another news outlet suggests that it isn't a research report per se that we should look for, nor is it published today, and the journal in question is neither of the aforementioned titles. Med Page Today (now with registration) notes that the results are presented as "a letter published in the October journal "Annals of Internal Medicine."
• Forbes also has the publication date as October but says that the authors are "reporting in a letter to the editor of the October issue of the Annals of Emergency Medicine..."
• Likewise, this is what the Boston Herald reports, however they are non-committal about the form of the research; "The findings will appear in next month's Annals of Emergency Medicine."
• Live Science plays it safe by listing no journal whatsoever.
• At least the publication Medical News Today helpfully provides a link: "You can read about this study in the October issue of Annals of Emergency Medicine". However the link takes you to the September issue and from there you can find some "teaser" October articles, none of which are this study, and as an aside the medical journal notes slyly that those articles will not even necessarily appear in the October issue.

So the study either appears in "today's" ("Monday's" as some vaguely reported it) or "next month's ("October's"), issues of either the Annals of Emergency Medicine, the Annals of Emergency Room Medicine (which is either non-existent or extraordinarily elusive), or the Annals of Internal Medicine. Maybe as a break from tradition the study will appear in all three places...or no place at all. The results are published either as a "research study", a "letter", or a "letter to the editor". Though two of the journals exist, we didn't find an accessible published article of any form. The only article we accessed was a press release here, that has some of the information propagated by many of the media sources and we're unclear as to where they're getting the spurious facts.

What sort of study did the authors (Brownstein, Reis and Mandl) conduct that warrants headline coverage in at least 82 (at last count) news outlets?

• Apparently "The researchers got data from the....Automated Epidemiological Geotemporal Integrated Surveillance system, or AEGIS, which is a disease-monitoring system that has been expanded for use by the Massachusetts Department of Public Health, [that] analyzes patient data anonymously and compares it with data from previous medical visits...."
• Or, as another source puts it, they were; "[b]orrowing data from a real-time disease surveillance system developed at Children's.."
• ABC's explanation is more simply put; the researchers "compared Neilsen television ratings with hospital traffic."
• But don't underestimate the amount of work this was...."After a week of late nights crunching and plotting data for the hours in question, Brownstein and Reis..."

We wonder, AEGIS sounds like sophisticated equipment, it must perform precise parsing. After all it was developed to assist in identifying infectious disease outbreaks. Surely the authors must have "crunched" some sophisticated results and have developed an interesting discussion from the data? Actually co-author John S. Brownstein reports slightly disappointingly: "We didn't look at reasons why people were coming in for care, we just looked at the numbers -- and the numbers dropped..."

So is it far-fetched to imagine -- we do our best to check facts but we're slightly in the lurch since we have only these disparate news reports at our disposal -- that despite the power of "AEGIS", we might have generated the same conclusion by standing at the emergency room entrance with a little clicker like they do(did) for crowd control at the ball games?

The authors cumulated the data from six hospitals (and rest assured, none of the hospitals was Mass General, that seems a stone's throw away Fenway's traffic nightmares) The authors note that only in the most dramatic events, like Game 7 of the ALCS against St. Louis, or to use another example - September 11th - will such effects be noticed. Other series games only generated a 5% difference, "slight" - as very few news agencies forthrightly reported. Apparently the reason the media is so enthusiastic about this...press release...is because:

• "Although previous studies have found a decline in health-care use during major sporting events, the Children's researchers are the first to quantify the magnitude of the events"
• As well, said study leader Kenneth Mandl; "These studies suggest that the timing of ED [Emergency Department] utilization has a strong discretionary component' "
• Finally; "The scientists say that this is the first study to illustrate a direct dose-response relationship between the popularity of a sporting event and decreased use of hospital ERs."

"Dose-response!?" Number of people in Emergency Rooms v. Number of People watching TV? (Aren't we striving to move away from this?) The study seems to be misrepresented and overblown by many media sources.

Although the press release notes that; "Previous studies had suggested a relationship between important sporting events such as the Super Bowl and hospital visits", the release wasn't explicit about previous research. Clearly, despite the coverage and interest, this isn't the most pressing issue for emergency medicine.

Nevertheless, some groups have published studies in this area. Similiar less quantified results were published by the Journal of Emergency Medicine in January-February 1994, in a study by NT Reich et al titled; "The Impact of a Major Televised Sporting Event on Emergency Department Census." Different studies showed that the percentage of total emergency room visits was often more sports related during major events -- trauma/alchohol related -- at least in Ireland. Mattick et al published in the Irish Medical Journal, March, 2003, titled; "The Football World Cup 2002 - Analysis of Related Attendances To An Irish Emergency Department."

We can't compare the studies, different though they might be, because we don't have access to the current or future published study. It seems most likely that the results will appear in some form in the Annals of Emergency Medicine and we'll suspend further judgement until we perhaps see it.

A reader contributes pointers to an interesting no-holds barred, multi-part article in the LA Weekly called "Clear and Present Danger". Specific to pollution in Los Angeles but relevant to many cities in the US and world-wide, the articles include diverse information from smog formation, health risks associated with pollution and the politics surrounding air quality issues.

Citizens living in places like Long Beach speak out about being subjected to large amounts of toxic diesel fumes and there are accounts from doctors who are working with ever younger populations of asthma and cancer patients. Educators continue to lobby for better air but it's unclear how much traction their getting on the issues. There are maps illustrating different risk areas within LA and timelines showing various legislative attempts and backsliding. The articles offer plenty of warnings and dire statistics but suggestions as well.

The Food and Drug Administration conditionally approved Inamed's reapplication to sell silicone implants. The implants were banned by the FDA for health reasons years ago, but in April an FDA committee suggested approving competing company Mentor's implants and the FDA acted on this in July.

The Boston Globe article notes that an association for plastic surgeons "paid travel expenses for scores of healthy women and their doctors to testify before the federal advisers in favor of relaxing restrictions on implants." The article proposes an explanation for the differential FDA committee treatment of the two companies in April:

"Some attributed the April rejection to fewer plastic surgeons on the advisory panel than at an earlier session, when federal advisers voted 9-6 in favor of Inamed's application."

However this explanation is different then what Acronym Required found in April when we read accounts of the committee process. At that time we reported on evidence revealed by the New York Times that the data produced by Mentor in April downplayed the risks of the implants by distorting evidence of manufacturing defects. While Inamed's reports to the FDA committee did show a higher leakage rate then Mentor's, Mentor's implants also had a large number of leaks and contamination, not to mention that they were sometimes "infected with fleas", however evidence submitted to the Times suggested that Mentor had distorted their manufacturing data to acquire committee approval.

Hurricane Rita is beginning to weaken, according to some of the latest reports. The central atmospheric pressure has increased from 897mb last night to 915mb today. There is a new eyewall opening, and maximum winds have decreased to 155mph, making the hurricane barely Category 5. The path has also shifted to the east, closer to the Louisiana border. Still nothing to be trifled with; meterologists predict that the storm surge will be 15-20 feet over normal.

In this week's issue of Nature (437,452), the editors propose that the science priorities of the Bush Administration might change in the aftermath of Katrina. They note that the US government; "has the propensity to adjust the government's spending portfolio quickly in response to particular events."

For example after September 11th, the government created the Department of Homeland Security (DHS): "with a large and ill-defined research programme, and diverted resources at the National Institutes of Health [NIH] towards activities related to bioterrorism". Acronym Required commented on these changes to NIH priorities earlier this year.

However, "there is scant evidence", says Nature, that revamping the funding targets furthered either science or national security. The article proposes that Katrina has the potential to bring to the fore issues of poverty and racial division, a development that might increase attention by the National Science Foundation (NSF) and/or NIH. The editors suggest that important research agendas may see increased focus by the administration - or not, they caution. For instance environmental issues may be better understood through continued research of the link between climate change and hurricanes and policy makers may pay better heed to water management.

Science communication is difficult, according to an article in yesterday's New York Times. Lisa Randall writes in "Dangling Particles", that "science plays an increasingly significant role in people's lives", therefore "faithful communication" is paramount. However, communication is "fraught with challenges that can easily distort discussions". Randall, a physicist at Harvard, lists multiple factors that confuse science communication.

What Scientists Miss

For one, terminology is often misleading. She gives the example of "Global Warming", a term that leads people to doubt science because "their winter was worse", colder, not warmer. More appropriate is the term "global climate change" she says. As well, "String Theory" could conjure images of the children's game cats cradle to the non-scientists, but for scientists brings to mind formulas, proofs and concepts that neatly explain how things are made.

Randall provides a balanced review of the challenges to communicating science. She points out that when the media present different points of view to achieve balance they fail the reader, because all points of view are not valid and research evidence changes over time. For example the body of evidence that supports "global climate change" has grown but the media continue their rote presentation of both sides of the story.

Modern science is complex Randall writes, so the problem of science communication is difficult but not insurmountable. She suggests:

• "Inculcate greater understanding and acceptance of indirect scientific evidence", such as the evidence collected from unmanned space flights, which is as valid as that from manned flights, she notes.
• "We might need different standards for evaluating science with urgent policy implications then research with purely theoretical value."
• "People need to realize that science is complex"...its not "only simple stories". Scientists, for their part, "should be willing to go the extra distance to give proper explanations"

The article presents excellent points, but starts with the assumption that we all agree that science plays an important role in people's lives. Scientists recognize that this is true. We walk into the kitchen and see polymers in plastic containers and microbiology at work in our refrigerators. We flip on the light and think at least to our introductory physics class. At mealtime we are stimulated to think about nutrition or the biochemistry of ATP synthesis and metabolism. Spicy sauce burns our tongues and we think about receptors and neurobiology. We go for a run and biomechanics kicks in, we see photosynthesis in the leaves and geology in the landscape around us. Science is everywhere; in the materials used in our houses, the air we breath and the gas we put in our car. However ubiquitous science may be, we doubt that the average person thinks like this because few have a science framework. (Actually many scientists don't think this way either.)

How Important is Science To You?

We all have more immediate priorities. We think about family, jobs, bills and vacation. Global climate change has perhaps affected the livelihoods of fisherman and people stuck in storms but for the most part, few people are affected in life-changing ways. However if by chance a person gets sick and realizes that in order to get the care they need they should understand diabetes or cell biology they may learn enough to manage their specific concern. But arguably, science knowledge is only required on a need-to-know basis.

Ignorance By Design

Modern science may be complex, but to the layperson it was also relatively complicated 100 years ago too. We were farmers then and needed to learn a fair amount of science relating to agriculture and farming. Then we became machinists in factories and now we're office workers. We've adapted our lives to science progress quite well actually; electricity, automobiles, jet travel, plastics, pharmaceuticals, electronic communications and triple bypass surgery. Even when bombs or viruses or the machine guns in our schools threaten us we quickly learn to manage the unintended consequence and detrimental byproducts of technology. Very few people completely understand the science behind these helpful or threatening life changes. And it's ignorance by design.

We're surrounded with technology but human interface designers toil to make the science and technology we use everyday "user friendly". They hide bits of technology behind colorful buttons and self explanatory icons. While science is clearly more complex for scientists today, technology for end users is deceptively simple. Businesses invest billions in assuring that the impact on people's lives is minimal. Technology is inevitably proposed as a way to "save you time", and "make things easier". In a way, we've become quite pathetic. We rely on technology like GPS units in our cars to guide us so we don't need to interpret maps. If you recognize this, it's therefore unintuitive that after decade of technology becoming more and more intuitive we should collectively reverse course and take time out of our stuffed dayplanner agendas to start figuring out science.

Randall is a theoretical physicist whose research involves "indirect science evidence", and she carefully notes that accepting "indirect science evidence" is not advocating "blind faith". But with the collective aversion for delving into complicated answers, nourished by decades of "user friendly" technology, it's difficult to imagine that perfect balance of intuition and analysis where as a society we would manage to masterfully suspend skepticism at all the appropriate times.

Marketing rules business, politics, entertainments, and yes, even science. It serves us by abstracting handy perceptions from facts and reality. Skepticism therefore becomes our key survival mechanism. Indirect science evidence will most likely be accepted not because of "inculcation" or analysis, but if and when the ideas become useful for the people. In the meantime, if new ideas threaten our individual paradigms without clear pay-offs or if they clash with easier to latch on to perceptions, we humans maintain an uncanny ability to promptly reject them.

Democracy -- Choose Your Science

We do have different standards for science with policy implications, though ironically it's not what the author proposes. Grant funding, marketing, and academic survival demand that we find ways to make science significant by connecting it by any means to potential lives saved, famines averted and diseases cured. However, if policy implications could potentially impact an influential sector in a negative way, the science in question is degraded, mocked, or questioned. When "climate change" science conflicts with goals of the powerful automobile and oil industries, we hear cries not for quickly acting but for further research. People align with one side or another not because of misunderstanding about science. They do so because conveniently, there are sides to be taken, and one side fits better with their desires and habits than the other.

Many articles fault the media for not communicating, for creating "sides", for kowtowing to advertisers. An article in The Guardian a couple of weeks ago skewered science journalism with exacting ruthlessness. However it remained unclear to this reader, when perusing the same column's other articles, what good science journalism actually entails. The Guardian itself isn't shy about spewing scientifically shaky news -- it reports regularly on "ufology", for instance.

Critics blame the media for misrepresenting science, but this often misses the real challenges of science communication that Randall presents. It is infinitely easier to find fault with the media, we know, than it is to write lucidly about original research or to note excellent coverage from any source.

Science is important. Science writing is important. In addition, politics about science is important. Suppose as science writers we forgot about communicating science, and spent all our time analyzing the statements of politicians and trying to find matches to those politicians possible agendas -- often unspoken but often obvious. Though I'm not advocating this but I believe we could potentially understand the issues as well as if we focused on communicating the science. Because it's not just about science, that's only a small piece of the pie.

Given recent political history, we citizens should be perfectly able to summon the skepticism to realize that the current administration chooses whether or not to believe global climate change. It is not for lack of credible evidence, or because too few scientists are taking the time to explain. Those pushing petroleum are not hobbled by the scant science news on the local evening TV shows. In many areas of science the administration is basing policy not on scientific evidence but in spite of it. In an age where politicians are constantly determining science policy based on the loudest lobby, it is as critical to grapple with this problem as it is to note the lack of attention to science itself.

The Carbon Disclosure Project (CDP) recently released the responses to questionaires sent to some of the world's largest companies about their carbon dioxide emissions. Increasingly, investors are more likely to consider potential regulatory risks in their investment portfolios and companies are more incited to take steps to manage potential climate risks. According to the executive summary "the cost of carbon may erode annual income by as much as 45%, depending on carbon prices, compliance periods and individual circumstances".

The project is a collaborative effort by a group of 95 institutional investors who control 21 trillion dollars in assets. The questionaire was sent to the FT500 ("Financial Times 500"), the largest global companies by market capitalization. The total emissions reported was 2,994,834,887 metric tons of C02e, which represents about 13% of anthropogenic global greenhouse gas emissions (GHG).

In its third year, the CDP has attracted greater company participation as a result of the increased attention to global warming, the ratification of the Kyoto Protocol, the EU Emissions Trading Scheme (EU ETS) as well as other imminent agreements. The first year 35 investors participated with $4.5 trillion dollars in assets and less than 50% of the companies questioned participated. This year over 71% of the companies participated.

The report drew a lot of data from a fairly simple questionaire but reading through the individual company responses is revealing. For many companies, as would be expected, this a marketing opportunity as much as an emissions survey. With a rapt group of investors the questionaire becomes an opportunity for corporations to expound not only on their efforts and conscientiousness around global warming but also their products. For example GM takes the opportunity to write that "in the U.S GM offers the largest number and proportion of fuel-efficient cars and trucks on a model-to-model comparison basis."

Some companies finessed their answers, particularly to the question that asks for a specific calculation of total carbon emissions. Mitsubishi Japan, explains that their company:

"..is a trading and investment company (sogo shosha) active in virtually every industry, including energy, metals, machinery, chemicals, food and general merchandise - although it is not a manufacturing company. Given the complexity of our business operations, our answer to this question [what are the total emissions for your company?] is therefore limited to the office activities of our head office in Tokyo and MCUK in London."

It is also obvious from the responses and this report's interpretation that responsibility is motivated by government regulations and market conditions. In all the sectors some companies were clearly ahead of the game in anticipating how global change could effect their business and taking steps to reduce their exposure.

Gas is more expensive in Europe - so accordingly cars are more fuel efficient. Many companies provided data if it was already required by another government agency, or answered that they would be motivated to take further actions when the business climate was ripe for that or when law required.

In keeping with impressions gleaned from a quick reading of the questionaires, the report reveals that although over 90% of the companies that responded thought that climate change posed commercial risks and/or opportunities to their business, only "51% implemented emission reduction programs; only 45% had established emission reduction targets."

However since 71% of the companies responded, those who "Declined to Participate" stick out from the list. Some of these "non-participants" are: Apple Computers, Best Buy US, Capital One US, Clorox US, Direct TV, Electronic Arts, Fannie Mae, Fedex, Fox Entertainment, Gannett, Harley-Davidson, Morgan-Stanley, Prudential, Symantec, Time-Warner, Walmart US.

As well some companies chose not to respond. "No Response" was indicated by AT&T Wireless Service/Cingular, Accenture, Aflac, Allstate, Amazon, Al Rahji Banking & Investment Corp Saudi Arabia, American Express, Amgen, Berkshire Hathaway, Bridgestone, Carnival, Cendant, China Mobil, Charles Schwab, Clear Channel, General Dynamics, Home Depot, Genentech, Oil & Natural Gas India, St. There are more. The report notes that some companies who didn't respond:

"despite CDP signatories holding more that 20% of their outstanding shares...in an era when the capital markets increasingly value disclosure and climate change is quickly rising up the agendas of major pension funds...the lack of responsiveness to the CDP information request does not reflect well on these firms..."

Overall, despite the worthy and wordy intentions, only 13% of companies that provided data in CDP2 (2004) and CDP3 (2005) actually reduced emissions, but importantly, this investor group and others are paying attention. The report as well as the individual companies responses are very interesting and the growing response rate to these questions is welcome.

People complain heartily about the plight of science in the United States, which has been pummeled by graduate student shortages, the erosion of public funding and support, and the paucity of science and math interest among the nation's youth - not to mention politics. For all its problem, the France's research community faces issues that put perspective on the US situation. France has two national agencies, the National Center for Scientific Research (CNRS), and the National Institute for Health and Medical Research (INSERM) that support many of the countries scientists and research efforts. Established scientists have long had job security since researcher jobs are career appointed civil servant positions. People argue that this system provides stability, however the system is widely viewed as being entrenched in cronyism and bureaucracy that inhibits creativity and handicaps young scientists.

France has stressed the importance of science research in the past decade, so that now the country graduates far more young researchers than can be supported, forcing researchers to move overseas. In addition, many national high-tech companies have moved abroad to do business. The French were especially goaded by the recent relocation of several biotech firms to the U.S. Biotech is just one industry that has lost ground to global competition. In April 2004 the government averted widespread strikes by scientists protesting lack of funding by vowing to fund science at higher levels and to create more positions. The government is challenged to reorganize many aspects of its research programs to stop the science exodus, and is considering the following options to stimulate investment and bring national research in line with more competitive nations:

• Employment restructuring to address the issue of ever-increasing salaries of life appointed civic employees who draw from potential appointments and salaries of new scientists.
• Taxbreaks for investors who become involved in public technology offerings for as well as taxbreaks for technology companies that start companies in France.
• Centers of research and higher education to promote collaboration between various parties - universities, industry and ecoles - and to fund and produce more competitive research.

France recently established a new National Research Agency (ANR), modeled after the National Science Foundation (NSF) or the German Research Foundation. According to a Science article, "New French Agency Tries Out 'Anglo-Saxon Style'" (August 26, 2005), the agency received a phenomenal response from scientists in its initial call for proposals. The new agency will be autonomous, and will replace the National Fund for Science and the Fund for Technological Research that were under the Ministry of Research. France is also granting money to the Industrial Innovation Agency which will fund solar energy, nanotechnology, biotechnology and bio-fuels.

Most proposals arouse anger from one front or another. Universities oppose ideas that may undermine their autonomy. Sauvons la Recherche!, a group of activist scientists, opposes government proposals that aim to bring together applied and academic research because they believe that basic research is the foundation of science and that applied research distorts the fundamental aims of national science. The group considers cronyism the root of many existing problems.

Scientists criticize ANR fear breaking with tradition and see the new agency as a threat to INSERM and INSR. Many scientists are wary of the U.S. system and suspect that the French government intends to gut established research funding by financially supporting such industry/academia collaborations through tax breaks and incentives in lieu of putting the money to salaries and grant funding.

While France faces struggles to remain globally competitive it is not alone among European nations in this quest. Most countries are struggling to compete on research fronts with the U.S. while simultaneously struggling with growing national debt. France and Europe also face competition from China and India, which offer cheap labor that attracts national companies, but are also growing competitive enough to compete head on with European innovation.

The California Air Resources Board relaxed gasoline evaporation standards Friday, enabling refineries to increase supplies. The rule will allow the sale of "wintertime" gasoline, which is usually not sold until October 31. As a result, 800 to 850 tons of hydrocarbon emissions will be added to the air daily. The action was purportedly taken to ease fuel shortages after Hurricane Katrina, however at the same time State Attorney General Lockyer is investigating whether price gouging or collusions took place on the part of gas station owners or refineries since California does not get oil from the Gulf. Although elevated prices may be reflective of decreased supplies, gas prices in California jumped to over $3 per gallon after Hurricane Katrina.

Nationwide, lobbyists are trying to eek out benefits from Hurricane Katrina and many of these also involve maneuvering around fuel shortages and elevated gas prices. Efforts are being made by airline lobbyists on several fronts, such as pressuring Congress to suspend payment of the fuel tax and asking Congress to mandate fuel surcharges for all airlines that wouldn't be included in the customers base fares. As well there is the usual push to permit drilling for oil and gas in Alaska, now intensified with increased perceptions of oil shortages.

Meanwhile, oil leaks in the gulf have caused tragic environmental consequences in some places in Louisiana. The Wall Street Journal" reports today, ("Katrina's Oily Waste") that at least six "serious" oil spills are among many that are devastating the environment. In Meraux, Lousiana, where the Murphy refinery is located, the ground is now covered with a lethal oil/mud mixture that is inches thick and seeping underground. The mixture creates a public health as well as an environmental hazard and although clean-up crews are busy vacuuming it up, the paper reports that up to 4000 houses may have to be razed because the oil is so difficult to remove.

Acronym Required previously reported on research about Nepalese porters who carry increased loads on their heads without having to increase their metabolic cost to the extent that thermodynamics would predict. African women utilize the same energy gains to carry heavy loads - also on their heads. Human gait works like an imperfect inverted pendulum; muscles propel about 35% of the energy fluctuations forward and back, up and down, and up to 65% of the energy is cancelled. The economized gait of the Nepalese porters and the African women is acquired with practice apparently, since novice walkers who try to carry loads on their heads cannot reproduce the same energy gains, they only (obviously) get sore necks.

Recently a much reported Science publication by University of Pennsylvania researchers tested a theory that the net energy gains of load bearing locomotion could be harnessed. To take advantage of the energy fluctuations in the up and down motion of walking they designed and built a knapsack incorporating springs and a mechanism that drives a generator onto an external frame. The load of the knapsack is allowed to move freely on the frame and the energy propelled by the load movement during walking powers a generator that can be used in lieu of batteries.

"Conceptually, it resembles the self-winding mechanism of an automatic wristwatch, where power is generated from an oscillating payload, excited inertially through the wearer's motion. Neither force nor displacement is imposed; both arise from the device's dynamics."

It will be interesting to see whether such packs can be optimized for use. We were initially skeptical because although the load only moved up and down 4.5 centimeters in their study, it seemed that the extra movement could create imbalance which could limit usefulness. The researchers report that the pack is reportedly comfortable however. As shown by the porters and African women, the extra energy involved with carrying the knapsack-generator device costs less metabolically then calculations show would be required both for powering the generator and for carrying the load. The research with the African women pointed out the different metabolic costs between load carrying on one's head, as opposed to a knapsack. Though a similiar mechanism is obviously in play, it's clearly not solely due to a difference in load placement. Previous attempts to harness energy from walking focused on generating energy from shoes or by attaching devices to moving limbs. It will be exciting to fully elucidate how this works and as well the experiments offer potential for alternative energy production in remote (or disaster prone) areas.

Preparedness

Katrina prompted little reaction from FEMA, but a overwhelmingly reaction from media and citizens. Perhaps FEMA's inaction made us realize the error of our assumptions about government planning at the local, state, county and national levels. If we were once complacent, we're reminded to pay attention and demand that agencies prepare for disaster. As well, we can't be unprepared ourselves.

But before we talk about that, there's one red herring that needs to be dispelled first, prompted by those odious officials who berate citizens for "insisting on living in disaster prone areas". These after the fact know-it-alls use disasters to parade out on their high horses, and crazy as it seems, this always gains traction with the media. The officious adminstrators can understandably never be found before the disaster. They're never spotted standing at the city hailing warnings to citizens as they move in, shop, do business, or go to work and bolster the region's economy. Yet when disaster strikes, there they are, lecturing hapless survivors about their choice of domicile.

Despite the hypocrisy, or perhaps because of it, citizens need to know the risks in their town and state and demand disaster preparedness. Where are the local dams, levees and fault lines? Have you stored extra batteries and gallons of water, noted fire-escapes, and collected valuable papers? Local resources such as chapters of the American Red Cross offer information and courses for family disaster preparedness.

If we are expected to be prepared, and indeed our lives depend upon it, we need leadership too. In the wake of Hurricane Katrina there's clamoring for "experienced disaster management" leaders. But do we know what a capable leader is? Some disasters happen once a century. One person or community's disaster leadership might be capable to handle a Category 2 hurricane, another's might collapse in a 6.3 earthquake, while another leader may fall apart when the toilet overflows.

To this end, FEMA has a cache of information on its website. The site (now being updated) has basic preparedness module descriptions on this disaster page. FEMA's independent study site has 50-60 multi-part training units ranging from "National Dam Safety Program", to "Metropolitan Medical Response System"(MMRS), "Animals in Disaster" and "Government Response to a Disaster Declaration" (The diagram below, though a tad psychedelic, is from this unit -- note the full circle solution)

The "Community Hurricane Preparedness" modules, and these on this site are aimed at professionals -- units like "Leadership and Influence".

Management

"Introduction to Incident Command System" (ICS), which gives disaster coordination guidelines for every event possible event - fires, tornadoes, floods, ice storms, infectious disease outbreaks, Super Bowls and parades.

"[ICS]was developed in the 1970's following a series of catastrophic fires in California's urban interface. Property damage ran into the millions, and many people died or were injured...Surprisingly, studies found that response problems were far more likely to result from inadequate management then from any other single reason. Weaknesses were often due to: Lack of accountability...poor communication...inefficient uses of available communcations systems...[no]systematic planning process..."

One project management perfect storm during Hurricane Katrina was interagency coordination, a management problem that was recognized decades ago before the Hurricane brought it to the fore. Thirty years after ICS was formed, communication in disaster preparedness and mitigation continues to fail, with numbing, mind-boggling regularity. But there's a training module to handle that too.

"Effective Communications" has "Success Tips for Media Interviews", which suggests ideas to "help you stay in control of the interview process". The advice includes "avoid speculation", remember to "speak in 'sound bites'", and "avoid wearing stripes, 'busy' patterns, and red." You should "never repeat inaccurate or damaging information spoken within a reporter's question". It doesn't address how to avoid spewing inaccuracies yourself, except to advise calling after the interview to correct the record.

Some say Brown and FEMA's response is symbolic of this administration or this century. Others say that bureaucracies are always inept. However government agencies can be effective, and as Acronym Required's earlier article, FEMA: Turkey Farm Redux. FEMA was at point, an effective agency. As for us, we can prepare, we do vote, do chose our leaders, our employees, and our politicians. Moreover, we should analyze our political choices with more care.

There is little time to dally. Hurricane Ophelia whirls menacingly off the coast of the Carolinas.

Shutting the Dike After the Flood

The head of the Katrina disaster and FEMA was sent packing back to the capital yesterday when the administration acknowledged that perhaps he wasn't doing such a "heckuva job" after all. The realization seemed to come with the same alacrity as the Undersecretary for Emergency Preparedness and Response Michael Brown came to grips with the strife of the stranded survivors. Despite the righteous indignation about the resumes and unpreparedness of the top FEMA officials, the level of indignation is somewhat curious.

These are the same FEMA people who have responded to disasters since 2003. Brown reported in a speech this year that in 2004, "FEMA responded to 65 major disasters and seven emergencies in 46 states and/or U.S. territories". He also led FEMA through multiple disasters in 2003. The loudest complaints before Katrina were about how FEMA gave out too much money in Florida to undeserving homeowners who weren't effected at all by a hurricane.

In some cases the criticism was a complete afterthought. The Denver Post wrote an editorial on December 4, 2003 titled "Good Pick For FEMA Successor", noting how Brown had the experience to lead the agency:

"He will coordinate response to any new terrorist attack...As FEMA's deputy director, Brown helped guide that agency's response to the Sept. 11 attacks, so he would bring firsthand experience to the heart-wrenching task...But he must also attend to FEMA's historic mission: helping communities respond to, and recover from, natural disasters...Brown has experience here, too, since he supervised FEMA's response to the massive Western wildfires last summer. He also held various local and state offices in tornado-plagued Oklahoma, so he understands how nature's rampages can devastate communities."

The paper only revealed the more dicey side of Brown's resume following hurricane Katrina. Is such hindsight useful?

FEMA and HDS deserve the wrath of the public. But one agency's failure does not absolve anyone else, culpability is not a 'zero sum game' and therefore it does not detract from the stunningly feeble federal response to point out that there were some flaws with the city and state responses too. Governor Blanco's administration no doubt deserves some heat for Louisiana's response, as does the city.

What Can Brown Do For You???? Good Question.

The Wall Street Journal published an article yesterday about the New Orlean's communication infrastructure collapse during the storm; "At Center of Crisis, City Officials Faced Struggle to Keep in Touch". The New Orleans' "command center" fell apart when the back-up generator ran out of diesel and land lines didn't work, and for the first two days the city disaster team was totally "in the dark". Cell phones were spotty at best, best being when staff leaned precipitously out of one particular balcony on one particular top floor of the Hyatt hotel where the team was holed up.

It only got worse when the levees broke. The mayor's group fought off potential looters and found themselves reduced to looting themselves as they ran out of supplies and ended up in the sorry strife as those they were charged with protecting:

"forced to rely on ingenuity [internet phone] and extreme methods, including breaking in to an Office Depot [to acquire electronics, servers, etc] --as the chief of police stood watch."

Today the fallout from the storm is personally devastating and civilly disruptive. The legal systems in New Orleans are scattered. The storm washed out lawyers, judges, plaintiffs, defendants and records. We believe that sophisticated banking networks and ever clever software technology precisely maximizes the banks profits while minimizing its risks in day to day transactions. However the local banks are now reduced to verifying customers via their employees' memories. Employees dole out cash to recognizable customers.

What Can You do about Future Brown's? Better Question.

A good part of our traumatized response is our fearful knowledge that many of us will face a similar disaster ourselves, in a San Francisco earthquake, a Missouri earthquake, a hurricane, a volcano, tornado or other tumultuous calamity. The faces on TV are close-up this time. Close, and not in a far away place where we are unlikely to vacation- the Andaman islands or Sri Lanka. Nearby, in one of very our own favorite cities, even if we've only been there for a convention. The Wall Street Journal article about the mayor's team's struggles tells us that "of 70 major cities in the U.S., the new Orleans municipal Web site was ranked dead last [in 2002] in a quality survey". This is silly of course. All the other cities might have superior websites but that does not reassure us of our fate - website quality does not predict disaster preparedness. But other things do.

While the federal reaction to Katrina was inept, Brown's removal serves merely as a totem of our collective despair about the untimely critical incapacitation of our technology, communications, and management systems alike. The outraged response to the government bungling of Hurricane Katrina aid is similar to the public furor and special election two years ago on the west coast where Californians, exasperated with state administrative quagmires, jettisoned Governor Gray and replaced him with Governor Schwarzenegger. That costly public response did not resolve California's problems, nor will Brown's banishment resolve our inability to manage stupendous disaster. It is psychologically reasonable that in the face of such a disaster we respond vehemently by blaming one person or agency -- but we should also consider broader actions.

The blatheringly inept response of government, combined with the state's and city's misjudgments should not blind us to our own participation. We vote, chose our leaders, our employees, and our politicians - the "public servants". Each public employee is an important one. We write editorials, we approve the agendas. We should remind ourselves now that those who we chose for their "loyalty", whose habit is to tell us what we want to hear, will not necessarily be most capable of thinking on their own when crises sweep away their cues.

FEMA Under the Bushes

Senator Ernst F. Hollings (D-S.C.) once described FEMA's staff as "as sorry a bunch of bureaucratic jackasses as I've worked with in my life". It was September 1989, in the aftermath of Hurricane Hugo. Hugo struck the Carolinas during the George HW Bush administration and it took FEMA ten days to respond. Three years later, Hugo survivors had a sense of deja-vu as they watched FEMA's response to Hurricane Andrew, which struck Miami-Dade county the morning of August 24, 1992.

FEMA is now the butt of criticism again in the wake of Katrina, and despite the differences in the scopes of the disasters, the Federal response to Hurricane Katrina by the younger George Bush 13 years later is much like FEMA's response to Hurricane Andrew, which his father George HW. Bush (Sr). presided over. But it you look back in history, there were times when FEMA actually excelled.

It wasn't in 1992, when mere hours before Andrew hit, Michele Baker, Miami-Dade's chief hurricane coordinator at the time, "took panicked calls from elderly residents", who weren't physically capable of evacuating. Baker had to inform them that no one could help them. (The Seattle-Times, May 28, 2000) Thousands of people were stranded without food or water and finally, following three long days with still no federal response, Dade county emergency management director Kate Hale lost her patience in a nationally televised news conference: "Where in the hell is the cavalry on this one...They keep saying we're going to get supplies. For God's sake, where are they?" (St. Petersburg Times, August 28, 1992)

"WE NEED HELP," a front-page Miami Herald headline implored August 28th. Stranded homeless survivors scrawled signs begging the president to do something and some took up arms to protect themselves. The Washington Post reported that food and water delivery was stalled:

"Roadblocks set up to stop looters continued to hamper delivery of emergency food supplies. Truckers with emergency food aid were forced to wait for police escorts after reports that some drivers had been shot and beaten by thugs. State troopers...began stopping all trucks entering the state, demanding that the drivers show that they and their cargo had been officially requested" (August 28, 1992)

FEMA didn't get supplies to Florida ahead of time because no official disaster had been declared, wrote the St. Louis Post-Dispatch: "While thousands of southern Floridians remained without adequate food or shelter, state and federal officials bickered...people waited in line: for food stamps, for mail, for Red Cross vouchers...[for] the Federal Emergency Management Agency." (September 1, 1992)

Pressured in a re-election year, Bush Sr. postponed his Kennebunkport vacation and repeatedly toured the area, offering sympathy to the citizens and TV cameras. He insisted angrily that his concern was not politically motivated and that it was no time for "finger pointing" and assigning blame.

FEMA, a "Turkey Farm" for presidents' friends

After Hurricane Andrew, Congress was vitriolic in its criticism of FEMA's hurricane response, roundly criticizing FEMA leader Wallace E. Stickney, a protege of former White House chief of staff John H. Sununu. Back then, chauffeured cars and long lunches were routine for FEMA employees, and an audit showed that a majority of FEMA's budget was still dedicated to preparing for nuclear war response. Some peope lobbied to have the agency disbanded altogether. Some thought that the military was the only agency that was capable of taking over disaster response. A House Appropriations Committee issued a report in 1992 that apparently said about FEMA:

"is widely viewed as a political dumping ground, 'a turkey farm'...where large numbers of positions exist that can be conveniently and quietly filled by political appointment." (Washington Post)

Similarly, current FEMA director Michael Brown -- "Brownie" to his pals, has the been the recipient of sharp criticism for his lack of diplomacy skills and his ignorance of the facts of the ground. The media, politicians, and citizens alike sense ineptitude and seem to revel in verbally flogging him, as FEMA slowly and haltingly responds to the Katrina disaster. No self respecting journalist has failed to hammer home the fact that Brown's previous post was with an Arabian hors equine association - IAHA. Even that position proved challenging apparently, because as one person put it: "he was not a horse guy").

This FEMA seems the same, but has actually changed since George HW Bush's day. When Bush Sr. lost the election and Clinton was elected, polls showed that vast numbers of FEMA employees wanted to leave- four-fifths of the employees polled thought FEMA was badly managed. Sen. Dianne Feinstein (D-Calif.) said: "I feel sorry for whomever heads this agency. The way it is structured, FEMA's role is to fail...I don't think FEMA can be a paper-pushing agency and a rapid response force at the same time." (Washington Post, January 28, 1993).

The James Witt Turnaround Under Clinton

However despite the qualms, the Clinton administration named James E. Witt to lead FEMA. Witt was an Arkansas native, a "country boy" with a high school diploma. Skeptics doubted his ability to lead such a large organization and questioned whether a "local official" with only four years of state-level emergency management experience and no college education could be effective. According to the Washington Post, to their qualms, Leo Bosner, FEMA union president at the time retorted: "Look at Stickney. He had tons of government experience and all kinds of college degrees, but he was a disaster." (April 1, 1993)

The old FEMA was completely revamped under Witt. Stickney was ousted but not before he held an award ceremony where he gave medals and cash awards to staff, aides, a firehouse in his hometown, and to Marilyn Quayle - because she had worked "in a dirty T-shirt and dungarees", during Hurricane Andrew (Washington Post Feb 17, 1993). Under Witt, the new agency had a place in the Cabinet and the ear of the administration.

Witt instituted "Project Impact", which led widespread initiatives from helping homeowners in earthquake-prone Pacific Northwest shore up foundations, to educating the hurricane prone regions. Disaster prevention, training, and education were as important clean-up. Clinton stressed the role of federal government in disaster recovery. There was no "drown it in the bathtub" mentality to get in the way of helping citizens prepare and recover from disaster.

Witt received kudos from Congress, from local officials and citizens alike for his leadership in the agency's turn-around. He oversaw federal relief efforts for hundreds of disasters - including the $ 5.5 billion Northridge, Calif., earthquake and the 1993 Midwest floods. A FEMA official said to the Christian Science Monitor (April 6, 1998): "After Witt, I don't think you'll see any other FEMA director come in who doesn't already have an emergency response background,". The Washington Post reported glowingly August 23, 1998 in; "It Took a County Judge to Bail Out FEMA; James Lee Witt's Arkansas Experience Reshaped Agency and Its Approach to Disaster": "Today, state officials who deal directly with the agency are virtually unanimous in their praise for the agency." Lee Helms, director of the Emergency Management Agency for Alabama, which had recently been through devastating tornadoes told the paper:

"I think there has been a total restoration of FEMA...Witt has cut out the red tape; there's much less bureaucratic nonsense and much more responsiveness to the state's needs. As we say in the South, he's got a head full of sense."

Jane Bullock, Witt's chief of staff who had worked at FEMA since 1980 when the agency was established under Carter, also praised Witt's accomplishments in the Post article. Not only were people not embarrassed to work for FEMA she said, but "we will never be the FEMA we were before".

Not so fast cowboy. In 1994, Sen. Barbara A. Mikulski (D-Md.) put forth a proposal to legislate the changes in the agency and praised Witt, but said she was worried that if Witt left:

"that response to major disasters will fall apart...We may go right back to political hacks who don't know the difference between responding to a flood versus an earthquake."

Senator Feinstein came to the defense of the organization, saying, "I really think FEMA is a new agency...it is the difference between day and night". (Washington Post).

Flash forward ten years to today. George Bush Jr. has been in office a few years, and now FEMA has been folded into DHS, subjected to multiple changes and re-sizing. Katrina is a monstrosity of a disaster, but so would be another terrorist attack or an earthquake in San Francisco or numerous other unforeseen crises. Trouble has been brewing in the agency for a while but perhaps Hurricane Katrina will have people suspecting that the old FEMA, the "turkey farm" banquished by Witt, has risen again. FEMA again needs triage.

FEMA doesn't fail because it's a government agency, it fails when a President puts at the helm another political appointee, someone with zero disaster experience, instead of someone qualified to do the job. What self-respecting president would run a business like that?

There's no lack of analysis about the hurricane and there's some blaming and responsibility shirking too. But when we finish our lengthy digestion of the news will we return to wringing hands about our faltering technical capabilities based on the number of Ph.D.'s graduating in US? Will we rhapsodize on about the newest technology and daydream about its potential to vanquish human catastrophe? No doubt, but even as we do, its clear that our technical prowess as-is often overwhelms our social wherewithall to employ it wisely.

Look across the ocean to the Netherlands. In 1953 there was a tidal surge from the North Sea that overwhelmed the sea dikes - or levees. Bart Schultz, adviser to the Dutch Ministry of Transportation, Public Works and Water Management spoke to NPR yesterday about the safety of the Dutch dikes. These dikes protect a third of the country's population and he quickly pointed out that while the hurricane system in New Orleans were built to withstand an event that may happen 1:100 years, the Dutch hurricane systems are built to withstand a storm that may occur 1:10,000 years. Clearly the risks are different in the two places but when he was asked about the enormous economic costs of the measures Holland has taken and the cost of his technical solutions he practically scoffed: "[that] is peanuts compared to the damage you have now".

The Dutch knew, but we did not? Bush asserted yesterday that no one knew of the dangers:

"I don't think anybody anticipated the breach of the levees. They did anticipate a serious storm. But these levees got breached. And as a result, much of New Orleans is flooded. And now we are having to deal with it and will."

His statement gives us pause; is our predictive technology that rudimentary? No, we know better, our technology is top notch. But did decades of loud clamoring for levee repairs go unheard? No, we heard the warnings. Are we then left to question the acuity our leader? "Not anticipated", "could not have predicted": The responses are business as usual.

Everyone has forecasted failures in the levees. A restrictive news search of one database using the terms "storm", "levee", and "New Orleans", yields almost 200 articles in the past 20 years, in "local" papers as well as papers in Toronto, New York, Florida, Pennsylvania, etc...The National Geographic, Science...the list goes on.

The current hurricane protection systems were authorized by Congress in 1965 after Hurricane Betsy killed 81 people in southeastern Louisiana. All of these publications predicted the potential demise of the old levees, many made out of clay. The levees have been repaired and improved but never to the extent necessary. Many knew that they wouldn't stand up to even a moderate storm. In 1993 Robert C. Bracamontes Jr., director of emergency preparedness for one parish noted that they might withstand at most; "a fast-moving category 3 like Betsy, but we'd be in trouble with anything above that."

The receding marshes excacerbated the danger. The New York Times reported on April 30, 2002 that Jack C. Caldwell, head of the state's Natural Resources Department said:

"...it has been difficult to find enough money to build up the protective marshlands. Washington has been disinclined to earmark billions to protect the marshland and has resisted appeals from Baton Rouge to share revenues from offshore oil production with the state for that purpose.

New Orleans has squeaked through potential catastrophes for years. There was a time when the city routinely recieved more of a pounding from storms. From 1909 to 1926, three major hurricanes and two storms that hit south Louisiana, according to the Times-Picayune. Recently, year after year, storm after storm just missed New Orleans. The storms had caused significant damage, evacuations and fear, and had served as ample warning to the dangers.

• Hurricane Danny caused $17 million to $23 million in damage when it struck on Aug. 15, 1985.
• Hurricane Elena caused $2.6 million in damage over Labor Day the same year.
• Tropical Storm Juan in October of 1985 caused significant strain in the levees in suburbs of New Orleans where 50,000 homes were flooded, several oil rigs were lost and there was $110 billion dollars in damage. (Times-Picayune- Oct 31, 1985)
• Hurricane Andrew in August 1992 prompted the mayor to evacuate the city. Officials then blocked exit routes (which are notoriously insufficient) because they didn't want people to be on the highway when the storm hit.
• Tropical Storm Erin swept across Florida into the Gulf of Mexico in June of 1993 and threatened to become a hurricane.
• Hurricane Georges in September 1998 prompted hundreds of thousand of people to evacuate and tens of thousands more to collect at the city's nine shelters including the Superdome. Georges turned out to be a Category 2 storm that only "grazed New Orleans, [but] had pushed waves to within a foot of the top of the levees" according to the Times-Picayune.

As the storms fortuitously changed path or lost force at the last minute to spare the city, the city continued to push its luck. But it was mere luck and the Times-Picayune as well as national and international papers warned repeatedly that someday thousands of people could die. One study predicted ominously that up to 60% of the citizens wouldn't heed a hurricane warning. It was a growing concern that the population had become nonchalant, too willing to gamble, insouciant, a storm like Hurricane Betsy was ancient history -- 30 years ago.

Holland's Shultz indicated that the Army Corp of Engineers knew full well what the dangers were and how long it would take to fix the levees once they were breached. Indeed the corps provided regular reminders about the dangers - Terrel Broussard, a corps senior project manager warned in 1993:

"People have to realize that flood protection is not necessarily flood prevention," said "People have to realize that these levees are not everything for every storm."

While the threat grew, rancorous politics got in the way of action and the appropriate repairs were stalled. Politicians failed to dispatch adequate funds, the bayou eroded further, the levees sank, and the danger grew. But as the city failed to rebuild, insurance options of all sorts were withdrawn. In June of 2002, the Times-Picayune headlined that "Insurance Companies are Pulling Out..." and the New York Times reported:

"The American Red Cross is taking the threat seriously. It has declared it no longer will provide hurricane shelters in the New Orleans area, saying that placing staff there in a killer storm will represent too much risk for its employees, volunteers and the general public." (April 30, 2002)

The collective dithering postponed repairs and as result the city and taxpayers are exposed to even higher disaster costs.

The catastrophe has familiar earmarks. We continue to shrug off our environmental threats with a *there's always tommorrow* attitude, and fail to secure those things that are most valuable to us. We're optimistic to a fault and fatally sanguine. Large scale flooding is something that China, Thailand, Vietnam and Bangladesh deal with. We assure ourselves that we're so savvy and technically capable and that we live in such a well-honed civil society. We're aptly horrified when when looters crack into stores to load up shopping carts of sneakers and towels. But we blithely loot our environmental resources and use tax dollars capriciously - our horror is so selective. We have adapted an inverted sense of thrift and environmental sensitivity. Perhaps Katrina will help us shed or at least shed light on these tendencies before the next storm.

[Update: In the September 16, 2005 issue of Science, authors Martin Enserink and John Bohannon write in "Questioning the 'Dutch Solution'", that the Dutch technology for keeping the waters at bay has some drawbacks. Aside from the cost of dikes and storm gates, one argument is that the dikes don't allow natural sedimentation to occur so engineers and low lying area denizens get caught in a cycle of needing to build ever-higher walls to accomodated the sinking land. An alternative to this, proposes one fanciful critic, is to "embrace the water", by building "floating cities" or hills underneath buildings. Another engineer calls such an idea "'romantic'". While the title turns out to be the most provocative part of this article and the alternatives presented seem controversial at best, the considerations will no doubt be important to rebuilding New Orleans.

In the end, most people agree that the ideal, where people don't live in disaster prone areas is not feasible. Economic considerations govern that people live in hazardous areas, and with our prevailing political priorities cost benefit analyses will continue to dictate that hazards cannot be controlled to the extent technology allows.]