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• PLoS and Elsevier: On the Same Page?

  One of our favorite things, in the Obama era, is to see would be foes band together. So we look fondly upon the unlikely albeit fragile "alliance" that PLoS and Elsevier ended up in at a recent open access publishing roundtable. The occasion was a report issued by the Scholarly Publishing Roundtable, convened by the U.S. House Committee on Science and Technology and the White House Office of Science and Technology Policy (OSTP). There were 14 publishers, university leaders, librarians, and other experts at the round table, who drafted basic agreements about how public access to journal publications. They emphasized:

  "the need to preserve peer review, the necessity of adaptable publishing business models, the benefits of broader public access, the importance of archiving, and the interoperability of online content"

  However, the Elsevier and PLoS representatives refused to join the other 12 members in signing the consensus agreement, although both agreed that points of the agreement were "positive". PLoS and Elsevier apparently both have a lot a stake, since they each sent extra representatives to the panel. Elsevier sent their General Counsel/Senior Vice President, and PLoS sent their Managing Editor as well as their CEO.

  Predictably, YS Chi, speaking for Elsevier, stated that he couldn't sign the agreement because it "supports an overly expansive role of government and advocates approaches to the business of scholarly publishing that I believe are overly prescriptive." No question about where giant, monopolistic, Elsevier ever stands.

  PLoS representative Mark Patterson's statement was a little more difficult for me to unpack. He said that the agreement "stops far short of recognizing and endorsing the opportunities to unleash the full potential of online communication to transform access to and use of scholarly literature." His whole statement was a similar whirl of words. What does he mean? He didn't include "the need to preserve peer review" as one of his "positive" points of agreement....But does PLoS want a more players around it? Federal support for PLoS? Explicit endorsement of pay to publish? A more "expansive role for government"? Someone knows, not me.

  For more information on open access and this agreement in general, there's a great public access policy forum here at the Office of Science and Technology Policy, and the "ever-enthusiastic public access policy team" at OSTP has extended the comment period. So you can comment, and there's lots to read.

• H1N1

  The World Health Organization (WHO), hits back at accusers who say that the organization, along with pharma companies, created a "fake epidemic" in H1N1. The World Health Organization reiterated its role to balance urgency and expediency with uncertainty. In an editorial generally praising the response to the epidemic, Nature wrote this week:

  "The danger now is that last year's relatively mild pandemic will create a false sense of security and complacency. The reality is that next time we might not be so lucky -- especially given that this time most of the world's population, living as they do in developing countries, had no access to either vaccines or antiviral drugs."

  It's easy, it seems to us, for very smart people to be cynical about the H1N1 pandemic. It is truly a challenge to explain risks and uncertainty of pandemics and the fact that the scientists and public health organizations are actually doing a great job.

Judge Overrules FDA on Electronic Cigarettes, Whatever They Are

Some people believe that a president's most lasting legacy is in the judges he appoints; George W. Bush appointed judge Richard Leon of the Federal District Court in Washington. Leon recently moved to stop the FDA from regulating e-cigarettes, on grounds that they aren't tobacco. In fact, e-cigarettes are battery-powered tubes that vaporize nicotine with tobacco flavoring, that simulate cigarette smoking for the user. I can't make that sound good. Seems like the next best thing to sex robots. But anyway, these devices deliver addictive nicotine to the body, but the judge says the FDA can't regulate e-cigarettes as devices anymore.

In other tobacco regulation news, an article in the New England Journal of Medicine (NEJM) discusses opposition to the Family Smoking Prevention and Tobacco Control Act on First Amendment grounds. Even the ACLU objects to the Act, which prohibits the use of certain words by cigarette advertisers, saying that

"regulating commercial speech for lawful products only because those products are widely disliked -- even for cause -- sets us on the path of regulating such speech for other products that may only be disfavored by a select few in a position to impose their personal preferences."

Instead advised the ACLU, "the antidote to harmful speech can be found in the wisdom of countervailing speech -- not in the outright ban of the speech perceived as harmful." But as the NEJM authors wrote:

"How did we come to believe that the exchange of commercial appeals in the marketplace of goods and services should be equated with free exchange in the marketplace of ideas? Are our freedoms really secured by a constitutional doctrine that would limit our capacity to inhibit the promotion of toxic goods? This is an opportune moment to reflect on these questions and their implications for the relationship between public health goals and the rules that should be foundational in a democracy."

• EPA's Updated Smog, Ozone Standard

  The EPA proposed new standards for smog last week, which would update the Bush Administration standards. The agency will set the "primary" standard, which protects public health, at a level between 0.060 and 0.070 parts per million (ppm), measured over eight hours, and will also propose a new secondary standard. These standards were recommended by scientists years ago to decrease deaths and smog levels dangerous to children, the elderly, and those with asthma and respiratory disease. As we wrote earlier, the Bush's EPA pushed the weaker standard of .075 ppm. We also wrote about the Obama EPA's stated intention to change the standard last fall.

• Airport Screening to Double as Healthcare?

  "We are headed toward the moment when screeners will watch watch-listers sashay through while we have to come to the airport in hospital gowns, flapping open in the back", wrote Maureen Dowd recently, commenting on holes in airport security processes. But I think she's seeing a cup half empty. We may well be headed for a moment when airport screening, reviled as a breach of privacy to some, is the closest thing to healthcare people can get.

  The public option has fallen "off the table" again, by now "fallen off the table" so many times that even when it intermittently appears back "on the table", it's obviously shopworn, if not smashed to bits.

  But the glass could still be half full. Think of the savings, if airport screening could double as healthcare screening : "You're cleared for flight sir, and don't worry about that lump..."

• What to Call It? Science Terminology

  For various reasons, political, scientific, logical (or not) or historical, people refer to the same thing using different terms. Here are two examples.

  Canada does not call the tar sands "tar sands", anymore, they're "oil sands". Of course "tar sands" is more descriptive of the energy-intensive process, of extracting oil, but "oil sands" sounds like something that you would naturally siphon some oil out of, it sounds better.

  In 2005, physicist Lisa Randall urged that "global climate change" was the appropriate phrase to use, because "global warming" would lead people to argue that their winter was actually very cold. Others argued that "climate change" sounded less dangerous, so therefore would be used to manipulate people who would be fearful enough about "global warming" to urge policy changes, whereas "climate change" seemed benign. But it gets even more complicated for some agencies. NASA differentiates between "global warming", which is surface climate change, and "climate change", and "global change", and "global climate change", which deems the most accurate term. I think everyone pretty much knows what everyone's talking about now, though I dare not make conclusions about that.

• Oh, and Happy Not-So-New Year

  Did you travel over your break? Have fun?

  In the US, marketing aimed at tourists is off the rails. Perhaps marketers have learned that people who travel in a heightened state of orange level stress will sooth themselves by buying absurd products. You may argue that it's a global trend, and indeed, the badminton set peddled to me by a man on the muddy backroad of a major city in Asia seemed ridiculous, until I flipped through Sky Mall Magazine and spied the "King Tut Life Sized Sarcophagus Cabinet" that can be "delivered curbside" (to impress your neighbors). Personally, I would rather pay to bat around a little white badminton birdie in a mud puddle, while talking baksheesh with kids who speak, at will, touristica French, German, English or Japanese. By comparison, traveler oriented products in the US seem conceived by desperate marketing departments who've lost their wits. Case in point -- the sarcophagus cabinet. Or:

  • If you were assigned to seating group 2 or above recently, on my least favorite airline I still fly on, you heard this announcement: "Board now. Enter via aisle closest to the wall, NOT THE RED CARPET." Because "the red carpet", actually a two foot doormat, is reserved for first class customers.

    Some people bemoan the lot of the economy passenger, the so-called "poverty parade", and the herd animal like treatment. But as a first class customer you pay an extra few thousand dollars to traipse across a red mat with bars on each side to keep you in bounds. Sure the legroom's nice, I won't argue, but you have to walk "the red carpet" to get there, and once there in that bigger, comfier seat, you're subjected to complimentary cheesefood snacks. Supposedly smart people actually buy this privilege.

  • At your hotel, you will be sold the usual-- rooms, room service, laundry services, shoe shines and upgrades, not to mention the mini-bar. But what if the five dollar peanuts in the mini-bar are too devilish a temptation for you and your New Year's resolutions? No worries, there's a market-based solution. Pay $50 to have the mini-bar hauled away at one hotel I was recently at.

  • Want to use the hotel refrigerator for your water? $50 fine at another hotel. And the same people who stay at these hotels complain that the EPA's bureaucracy confines their business style.

  • Maybe you actually love business travel and want to bring home a bit of the experience, like the "pulsating" showerhead that your can actually buy from one hotel's glossy catalogue. The catalogue carried other mundane household hardware and dog cushions stamped with the hotel's logo. Pretty special.

  Couldn't we just travel unsolicited sometimes? Definitely not in 2010. Happy New Year.

• Copenhagen: Despite walking past sculptures of skeletons and eerie melting ice polar bears and mermaids daily, the climate change delegates collectively refused to come up with anything substantial in Copenhagen. President Obama curtailed his much awaited visit, altogether minimizing his association with what was by most accounts a failure, but also known as an accord, in order to fly home early and beat a snowstorm. If we are one world we are also many countries with our own economic interests in mind.

  Is there a better way? The Economist suggested in an article last week that the talks may have gone better if different regions and pollutants were considered separately. While the idea is interesting, this sort of regime is also how fishing interests repeatedly fail to establish effective ecological safeguards and effective quotas.

  Although the talks weren't considered fruitful, an interesting sidenote is the inability of very tenacious climate change deniers to convince delegates or the thousands of protestors in Copenhagen that climate change is a hoax, that nothing's at stake.

• The Ice Floe Debate: Last month, in our Notes on Science Dust-Ups and Dirty Laundry, under "Curly-haired Science Populizers Spar" we wrote about what we'll call the IQ nurture:nature debate between two science popularizer giants, Steven Pinker and Malcolm Gladwell. Pinker had criticized Gladwell for what he cuttingly labeled the "Igon Value Problem", defined as, "when a writer's education on a topic consists in interviewing an expert, he is apt to offer generalizations that are banal, obtuse or flat wrong."

  In return, Gladwell wrote that Pinker might be "unhappy" with him for not joining him on the "lonely ice floe of IQ fundamentalism", and criticized him for quoting bloggers. (Although if not for bloggers there might not be people in science of lower regard in the research hierarchy than some of Gladwell's mashable social scientists -- just saying.)

  After we left off, Pinker responded to Gladwell that IQ was related to "many important educational, economic and social outcomes" according to "52 signatories" and "a unanimous blue-ribbon panel". Gladwell then raked over Pinkers' sources, detailing how 15 of those 52 signatories belonged to a group founded by a eugenicist -- whose members are racists, eugenicists and sexists. After substantiating his response at length, he concludes:

  "The fact that ideas are sometimes supported by people with unsavory connections does not make them invalid. An ice floe is not necessarily a bad place to be. It's just that if you are plainly floating on one, it doesn't make much sense to insist that you are standing on solid ground."

  Although both science popularizers are getting more popular via the dispute, there are important issues at stake here. (Acronym Required previously wrote "Watson Uncut: Surprising? Boring? Racist?)

• Racism Persists: Psychology researchers at Yale University found that racism persists, despite US society's more tolerant overt attitudes. The psychologists studied nonverbal interactions between white and black characters on television shows, then surveyed study participants for their responses to the actors attitudes. (complicated methodology) They conclude that nonverbal behavior towards minorities on television influence the attitudes of millions of viewers.(Dovidio et al Science(326) 1641 - 1642 DOI: 10.1126/science.1184231)

• Larry Summers Summons the Economy to Man-Up: Larry Summers is overly optimistic on jobs says a guest blogger on Naked Capitalism in the article titled: "Larry Summers Is Like a Guy Who Yells That the Sun Really DOES Revolve Around the Earth and that the Current Orbit is Just a Temporary Aberration . . . and That If We Just Wait a Little While, Everything Will Return to Normal". We last reviewed Summers's history of unfailing optimism in Mission Accomplished: Summers Ends Economy's Free Fall.

• Coaxing The GOP To Eat Arugula: Michael J. Petrilli questions the GOP vote getting strategy in Wall Street Journal. The Hoover Institute Fellow observes that "with the white working class shrinking and the educated 'creative class' growing", Republicans such as Sarah Palin, "whose entire brand is anti-intellectual", and GOPers who brand themselves for "working-class families", "Sam's Club Republicans", and "your co-worker not your boss", might be miscalculating. Petrilli's assessment of those who criticize "Eastern Elites"? "Playing the populism card looks like a strategy of subtraction rather than addition". Instead he suggests: "What is needed is a full-fledged effort to cultivate "Whole Foods Republicans" - independent minded voters who embrace a progressive lifestyle but not progressive politics."

• South Africa's Ex-Health Minister Dies: South Africa's Dr. Manto Tshabalala-Msimang died of complications from a liver transplant she had two years ago. As Health Minister during the Thabo Mbeki administration, she was known as "Dr. Beetroot" for her suggestions that lemon, beetroot and garlic would protect AIDS patients against the deadly effects of the disease in lieu of antiretrovirals. Mbeki's administration oversaw the fraught handling of the AIDS crisis in South Africa, and the former president went to great lengths to protect his comrade Tshabalala-Msimang, who attracted international attention for her positions.

  Even the Minister's liver transplant was controversial. The Times wrote in Manto: A Drunk and a Thief, of a Health Minister who was an alcoholic with liver cirrohsis -- a kleptomaniac on bad behavior while in hospital. One hospital employee told the paper that Tshabalala-Msimang's "antics were common knowledge among staff.'Everyone here thinks its hilarious that she is today a health minister in South Africa'". The story questioned whether favoritism and power enabled her to receive a liver transplant ahead of others.

• Sickle Cell Anemia Not the Only Genetic Mutation to Protect Against Malaria: We learned in our biology courses that the genetic mutation that causes sickle cell anemia is an adaptation to the malaria causing parasite Plasmodium falciparum. Recently, scientists at the Pasteur Institute in Paris have shown that a less common malaria causing strain, Plasmodium vivax, has also caused adaptive pressure on the genome. The scientists found a gene variant associated with an enzyme deficiency which seems to protect against infection by P. vivax in Southeast Asian populations. The variant causes a deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD), associated with neonatal jaundice and hemolytic anemia after exposure to certain infections, foods, or medications. (Sakuntabhai et al Science 326, 1546-1549 (2009)DOI: 10.1126/science.1178849)

• Cookstove Technology: Indoor pollution causes 1.6 million deaths per year. Cookstoves contribute significantly to indoor pollution, especially in developing countries where morbidity and mortality from cookstoves disproportionately affects women and children. The New Yorker recently published an article about an Oregon company (one of many) working on cookstove technology for developing countries. An efficient cookstove will vent smoke out of the dwelling and will also burn fuel effectively, saving both lives and forests. But as the article shows, it's about more than technology -- there's many ways a cookstove can not work in developing countries.

Trick

Scientists sometimes confuse people with inscrutable acronyms -- BPA, NIEHS, NTP, EPA (bisphenol A, National Institute of Environmental Health Sciences, National Toxicology Program, Environmental Protection Agency), words that are difficult to pronounce -- "phthalates", or words that are difficult to get to the end of -- "Pneumonoultramicroscopicsilicovolcanoconiosis". But lately, we've been stumping people with words everyone thought they knew, like "trick". People went wild over the idea that East Anglia scientists had used a "trick" to manipulate raw data.

"Trick", previously associated with annuals "treats" and six year olds in fairy costumes, was suddenly linked to nefarious acts. Yes, there is that "trick", but it's not often used¹. And did the media mayhem over "trick" top the media mayhem over the breast-baring wardrobe malfunction during Super Bowl half-time a couple of years ago? Hard to say -- but global warming is actually serious.

Scientists explained over and over that "trick" can be a good thing, like mathematics, logical thinking, transparency, pragmatism, maybe even dignity for life -- but their insistence only increased suspicion and talk. "Trick" dominated the news cycle longer than any five letter word should be allowed to and even wormed its way into events like the US legislature, where senators leveraged the word in committee meetings to veer away from very important topics like the Toxic Substances Control Act (TSCA)².

Now we see the word all over the place. And like the original East Anglia "trick", it's often used to rationalize why climate change, the reality, isn't being translated into climate change policy. The Financial Times reported on the tension between China and the US in Copenhagen and quoted China's on its changing stance:

"'China will not be an obstacle [to a deal]. The obstacle now is from developed countries,' he said. 'I know people will say if there is no deal that China is to blame. This is a trick played by the developed countries. They have to look at their own position and can't use China as an excuse...'"

John Tierney recently used the word to propose a temperature based carbon-tax -- a joke perhaps, or to scoff at science?

"[U]se the temperature readings as the basis for a carbon tax instead of a cap-and-trade system...the carbon tax would be more effective at reducing emissions because it is simpler, more transparent, easier to enforce and less vulnerable to accounting tricks and political favoritism."

Up to his usual tricks, that Tierney.

Talking about the challenge the US Senate presents for Obama in Copenhagan, Jason Grumet, president of the Bipartisan Policy Center described Obama's challenge as a "Goldilocks Problem":

''The trick is finding something just right in balancing the importance of demonstrating international leadership while not undermining the legislative dynamic here at home.''

Moving away from climate change, the word "trick" can morph from a bad thing or a challenge, to a good thing. An author recently mused in an essay in the New York Times about the "tricks" to maintaining a marriage.³

Hack

The confusion over "trick" is not entirely unjustified. Merriam Webster has seven possible uses of "trick". And another word that's ambiguous for some people, again, reasonably so, because it has nine uses in Merriam Webster, is "hack", as in, they hacked into the email server in East Anglia and stole a thousand emails.

During the December 2, 2009 hearing on the pressing imperative of revising the "Federal Toxic Substances Control Act" (TSCA), climate denier Senator Inhofe (R-OK) hijacked the meeting to windbag on about "tricks" in emails necessitating a halt to EPA emissions rulemaking.

Senator Boxer (D-CA) responded eloquently and forcefully, noting that although she was concerned about criminal acts of "hacking", she was more concerned about anthropogenic carbon emissions, about global warming, and about the repercussions for human health -- that's where her duty was, to the people effected by global warming. About the email break-in she said:

We're dealing with a criminal act of hacking into a computer...It seems to me they must have been hacking this for years. And just before Copenhagen they came out with it...That's what it seems to be...because, these emails, they go back...how many are there? Over a thousand emails? So I don't know how long a thousand emails...

This may be a silly example, but it shows how people with expertise in a particular area assume common understanding of simple words. Here it seems like "hacking" into a computer is visualized as George Washington trying to "hack" down a giant redwood tree in the Muir Woods National Park.

Hack can mean to chop at roughly. It can also mean to tolerate or bear something, for instance, I don't know how Senator Boxer can hack Senator Inofe's perennial global-warming-is-a-hoax B.S. so gracefully. Used as a noun, hack can also be a cough, a horse, a worker, or (derogatorily) someone who misconstrues or butchers something -- for example, Senator Inofe is a real hack when it comes to science and global warming.

But when someone hacks into a computer as they did in East Anglia, they exploit a vulnerability in order to access data owned by someone else. Different than hacking at a tree. It can take a computer hacker a while to find the vulnerability and locate the data, but then they most often swoop in, get it, in this case a bunch of emails, and go. Sometimes they lurk about, poised to commit further crimes, or leave an opening to come back, obviously there's no rules, but generally they're not hewing emails out of the server one at a time over many years 465 -- hack, hack hack, 466 -- chop, chop, 467 -- hack, hack -- that's a different use of the word.

The Trick for Scientists, If They Can Hack It

So "trick" can not so intuitively mean find a solution, as well as to deceive, and "hack" can mean deceptively break into a computer in order to plunder or pillage, as well as to chop at something. And confusingly, computer scientists, sometimes known as "hacks" but in a good way, will "hack" a solution to a very tricky programming problem, just as scientists use a "trick" to help analyze and make sense of data.

And that's the challenge for scientists -- a trivial one, but another one. In addition doing science, teaching, writing grants, motivating grad students, negotiating politics and budget cuts, actually physically looking out for hackers and those who would break into scientists offices and steal computers as part of a global effort to undermine climate science; in addition to assessing threats of bodily harm, scientists need to simplify concepts, avoid acronyms and watch their use of simple seeming words whose meaning they take for granted.

All that work because even people with the best intentions don't always have a grip on either science or its lexicon. And once scientists sort out "trick" and "hack" for everyone, they'll then face the greater challenge of explaining the risks of doing nothing about global warming, with the risks of doing something. After all, probability and risk are orders more challenging for people to grasp than "tricks" and "hacks".

--------------------------

¹ See, "Do Names Portend Profession?", in AR's Science Dust-Ups and Dirty Laundry

²

We wrote about TSCA here. Of 80,000 chemicals produced, there's little information about which ones are on the market, and only 5 are regulated by the EPA.

³ In the NYT on marriage: "Recently one of my wife's college students kept pressing us, with baffled curiosity, for our secret, as if there had to be some trick to it..."

In his most recent column, Thomas Friedman marshals ideas from Ron Suskind, Dick Cheney and Cass Sunstein in calling for action on climate change. By the end of his column, Friedman has reminded readers of decades of research showing that greenhouse gases make the planet warmer, with the "potential to unleash 'catastrophic' warming." Which risk should we take, he asks? Should we increase our efficiency and mitigation efforts, then in the unlikely event that climate change weren't critical, "as a country we would be stronger, more innovative and more energy independent"? Or should we risk not preparing, then if climate change were a catastrophe, "life on this planet" would become "living hell"?

Before we get to these arguments in "Going Cheney on Climate", though, you must grapple with Friedman's interpretation of Dick Cheney, Rons Suskind and Cass Sunstein. It's unclear why Friedman chose them, perhaps to convince the GOP, or any deniers, or those who are swayed by deniers, to support climate change action? Anyhow, using their ideas makes his argument confusing.

The One Percent Solution and Climate Change

Friedman refers to Ron Suskind's book "The One Percent Doctrine", titled after a comment Dick Cheney made in 2001:

"If there's a 1% chance that Pakistani scientists are helping Al Qaeda build or develop a nuclear weapon, we have to treat it as a certainty in terms of our response..."

That part Friedman gets right. But Suskind was actually extremely critical of Cheney and the "Cheney Doctrine". Why? Here's the rest of Cheney's comment:

"...It's not about our analysis, or finding a preponderance of evidence...It's about our response""

As Suskind wrote, Cheney's new world order demanded action despite evidence:

"Justified or not, fact-based or not, 'our response' is what matters. As to "evidence", the bar was set so low that the word itself almost didn't apply." If there was even a one percent chance of terrorists getting a weapon of mass destruction- and there has been a small probability of such an occurrence for some time -- the United States must now act as if it were a certainty. This was a mandate of extraordinary breadth...

Cheney's new US policy direction meant commitments from citizens and libraries as well as all levels of government -- the the CIA, the Army, the NSA, the Treasury. The costs were stupendous. As Suskind wrote:

"all parties took a vow of sorts on Sept. 12...vowed to work each day and every night...They'd stop at nothing...Global accords on everything from greenhouse gases to international courts...now were seen as constraints...Such agreements were for lesser countries. They were to be shaken off...

Suskind criticized the Cheney Doctrine precisely because its framers willfully disregarded evidence about the negligible risks of Al Queda gaining nuclear capability. They charged into war despite the evidence.

The situation with climate change is the opposite, the evidence for climate change is substantial. A cartoon in the Atlantic Constitution this week summarizes the folly of the deniers. A woman, speaking sometime in the future, says: "The North Pole melted. Polar bears are extinct. Asia's under water. Africa's a desert." The guy next to her responds: "Hey I never said the global warming hoax wasn't elaborate."

Adding to the confusion of Friedman's line of persuasion, the Cheney Doctrine leaves no doubt about that administrations sentiments on climate change, since according to Suskind the US took greenhouse gases off the negotiating table under the Cheney Doctrine.

Friends or Foes? Friedman's Folly

In addition to Suskind and Cheney, Friedman pulls in Cass Sunstein to wrap it all up, saying

"Sunstein wrote in his blog: 'According to the Precautionary Principle, it is appropriate to respond aggressively to low-probability, high-impact events -- such as climate change. Indeed, another vice president -- Al Gore -- can be understood to be arguing for a precautionary principle for climate change (though he believes that the chance of disaster is well over 1 percent)."

Here, Sunstein was actually criticizing the Precautionary Principle, and by extension the Cheney Doctrine, and most likely Cheney and company would bristle at being compared to Gore. According to Sunstein the Precautionary Principle muddles and stalls appropriate action on climate change. ideas he spelled out in papers, articles and books like Laws of Fear: Beyond the Precautionary Principle", and "Risk and Reason: Safety, Law, and the Environment", his 2002 book.

Sunstein uses social science research to show that individuals are susceptible to faulty conclusions based on irrational fear and errors in judgement like "availability heuristics". Sunstein argues that instead of the Precautionary Principle, the risks and benefits of action on suspected perils should be evaluated empirically. On global warming, he suggests cap-and-trade agreements and incentives to motivate players to make choices to limit emissions, rather than regulation. In a 2008 Boston Globe essay, Throwing Precaution to the Wind, Sunstein specifically uses the example of Bush's Iraq War as a precautionary tale for dealing with global warming:

"the Bush administration justified the war on explicitly precautionary grounds - that even the possibility of a nuclear-armed Iraq was so threatening that it demanded action. Indeed, the idea of "preemptive war" articulated by President Bush is a kind of precautionary principle. The nation went to war on the chance that Saddam Hussein had weapons of mass destruction. But this precaution is imposing a heavy price and creating serious risks for the future."

Sunstein warns against regulation, saying that regulation can invoke unforseen risks or even death -- banning DDT he says caused deaths from malaria -- a spurious argument, but one he uses along with others to warn people off the Precautionary Principle.

The "Cheney-Thing" on Climate - Something to Get Behind?

In the end, Friedman says:

"When I see a problem that has even a 1 percent probability of occurring and is "irreversible" and potentially "catastrophic," I buy insurance. That is what taking climate change seriously is all about.""

Cheney might use the one-percent argument to go to war, but he did so to invoke fear in the American public in order to gain their support. Suskind did not support the Cheney Doctrine, because it wasn't based in evidence and fact. Sunstein also criticized the Cheney Doctrine, comparing it unfavorably to the Precautionary Principle. Now Friedman incongruously corrals the whole mix to support: "doing the Cheney-thing on climate -- preparing for 1 percent." I'm not sure quite what to make of this kind of endorsement.

When "Effective EPA" is No Longer an Oxymoron?

The Environmental Protection Agency (EPA) finalized the agency's finding last April that greenhouse gases "(GHGs) endanger public health and welfare. Jackson reminded viewers that the Bush administration EPA had found that greenhouse gases endangered health and welfare, action compelled by the 2007 Supreme Court ruling in Massachusetts v. EPA, but had "regrettably" stalled on moving forward with the agency's recommendation offering only "excuses" and "delay". Said Jackson: "this administration will not ignore science or the law any longer, nor will we avoid the responsibility we owe to our children and grandchildren."

Having finalized the Endangerment Finding, Jackson announced some first steps:

"Next month, large emitters in the U.S. will begin working with EPA to monitor their emissions. Beginning in 2011, large emitters will - for the first time - submit publicly available information that will allow us to meaningfully track greenhouse gas emissions over time....And starting next spring, large emitting facilities will be required to incorporate the best available methods for controlling greenhouse gas emissions when they plan to construct or expand."

The agency noted that it had no intention of putting burdens on small businesses.

The Indefensible Status Quo and Republicans Think They're Deep Throat(?)

Last weekend we wrote about a group of GOP Republicans who asked the EPA to withdraw the Endangerment Finding because of the CRU emails. We noted their tone of desperation, for instance that they tried to make their case by quoting an infamous, non-sensical UK climate denier. Jackson addressed the skeptics, and noted that the EPA's action was based on decades of research.

"We know that skeptics have and will continue to try to sow doubts about the science. It's no wonder that many people are confused. But raising doubts - even in the face of overwhelming evidence - is a tactic that has been used by defenders of the status quo for years. Those tactics have only served to delay and distract from the real work ahead, namely, growing our clean energy economy and freeing ourselves from foreign oil that endangers our security and our economy."

True to form, last week Representative James Sensenbrenner(R-WI) had said that CRU emails were "evidence of scientific facism". Today, having worn out facism, communism and nazism and Hitler references, EPA letter writer Representative Richard Issa (R-CA) summoned fellow Republican the deceased Richard Nixon for his incoherent campaign. Responding to Jonathan Pershing's (U.S. deputy special envoy for climate change) observation that the emails were inconsequential and the science on climate change was "incredibly robust", Issa declared: "Richard Nixon said that about what Deep Throat had outed about the break-in."

Green Jobs, Pragmatism and Details

Jackson noted that today's action would also assure the American people, scientists, and the world that the EPA is serious, after eight years of inaction, about acting on the challenge of climate change. She hoped that recent EPA action would restore the "credibility and the trust of the American people" by taking an "enduring" and "pragmatic"

"step[s] towards innovation, investment and implementation of technologies that reduce harmful emissions...green jobs, reduced dependence on foreign oil, and a better future for our children."

These are great steps for the EPA, although we recognize the devil is in the details. Just as the work wasn't over once Obama won the election, the work isn't over now that the waiver is finalized.

Of Course Denial Is Not The River In Africa:

The upheaval over the climate e-mails is business as usual for the climate science deniers or denialists - not "skeptics", and just a word on that first. Scientists are by nature "skeptics" and consider skepticism a valid approach to analysis. Merriam Webster says "skeptic" derives from the Greek skeptikos thoughtful, or skeptesthai to look. However, unfortunately for all of us, the climate data needs to be denied to be disbelieved. There's too much of it over too many years from too many different fields -- too much evidence to be skeptical about. Meanwhile, while some deniers happily call themselves deniers, others deniers take extreme offense, saying calling them deniers is dismissive or denigrating. But that's not the goal here. I'm not saying deniers don't have feelings, they have valid feelings, and they may also have issues facing reality or other problems.

For instance, just as people who don't recycle may sincerely have difficulty separating cans from cardboard, climate deniers may be incapable of swimming. We can empathize. Swimming may become an even more vital skill in the future. Deniers may fear being seen driving an electric car, fear heatstroke, fear malaria, fear fire, fear tornadoes, fear heatstroke, or fear moving from Florida, which could be affected most by impending climate change with rising sea waters, temperatures and incidence of malaria. Fear may incapacitate deniers reasoning faculties or propel them to convince themselves and others that no change is necessary. We empathize some more.

But if we chance-it, do nothing because of deniers' fears, so we can talk about emails in the UK some more, then we're making a choice that has the potential for far scarier outcomes than facing the mounds of evidence and choosing to do something. And we can do something, we can change, we can support industries that solve climate problems. Or we can do business as usual, and suffer the economic consequences of that. There are all sorts of innocent reasons why deniers are in denial. Only some of them nefarious like fear of losing the vote. But denial for any reason thwarts problem solving.

Rearranging The Deck Chairs on The Titanic. Well..?

We don't necessarily understand their reasons, but we recognize the deniers' rhetoric. If decades of ice core data, Antarctica data, arctic data, temperatures, sea levels, temperatures and, corral bleaching, tree ring data, and more, all show global warming over decades, they'll say "but today is cold out - global warming? Hahaha". If there's noise in a 30 year graph showing an up or down trend, they focus on a one year time period that shows the opposite trend, and throw that out as "proof" that the graph is false.

Here's one video, just one piece of evidence in mountains of available data, showing the decrease in perennial sea ice (seconds ~25-50):

Deniers will ignore all the evidence, focus on a bunch of emails and call it ClimateGate, and get everyone to run over to the starboard side of the ship, when there's an iceberg forward (although, actually, eventually that won't be a problem anymore.) Or they'll say the problem is that the scientists weren't communicating and weren't being transparent with the data. Of course last year the Wall Street Journal was complaining about "too much" global warming evidence. We're not saying that scientists shouldn't have thought twice about pouring vents and frustration into emails, but this is the sideshow which keeps us all spinning, keeps us doing nothing.

Meanwhile, if the sea level of the Mediterranean Sea rose 1 meter, the Nile River Basin, home to millions and cultivated to feed more millions, would lose 6.1 million people to displacement. Where would they all go? 4,500 square kilometers of Nile River Basin cropland would be lost, and the World Bank estimates a 6% loss in GDP to Egypt, and direct GDP losses for about 10 other countries. 6% GDP impact would raise to 16% with a 5 meter rise of sea level. That's one area of the world and one river basin, there's many others. Louisiana and Florida will be lost to rising seas. California and Australia will have more forest fires.

And while many results of climate change are known, other possible changes could be even more catastrophic if they happened. This is the case with The Great Ocean Conveyor Belt or thermohaline circulation. Scientists don't know what the outcome of the collapse of the thermohaline circulation would be. They don't know how that would further change climate, which areas would be warmer, how it would effect ocean salinity. Would the ocean become a pond? Scientists can't predict, but there's a chance that it could be catastrophic. There's never absolute surety in science, but the outcomes can be different both ways, better, or a lot worse.

Deniers like Inhofe would be brandishing threats about emails if he were in hip-waders up to his waist in sea water, rather than accept the evidence. That's the way its always been and that's the way it will always be. Fighting against mult-million dollar "pro-industry" campaigns by oil companies and the people they corral with their ideas, like Inhofe, has occupied scientists as much as the science. So when some people, (including scientists) now turn around and say that scientists need to be more transparent, if doesn't ring true. The data has been there and still is. These 'scientists aren't talking right' distractions only derail scientists from looking for solutions.

Progress and Promises on AIDS:

Today, on World AIDS Day 2009, while looking for a statistic, I entered into Google the search: "HIV infections decrease". The sometimes precocious search engine offered an instantaneous correction: "did you mean HIV infections increase" [sic] No, I silently answered, frowning, before I caught myself attempting communication with a search engine. Then I flipped the search to Google News. Google insisted I must mean "increase". So I got the statistic I was looking for and relented to Google's know-it-all suggestion. Indeed although Google was wrong, I understand the reasoning, even if only algorithmic: The first search phrase, "decrease", yielded only 1,940,000 results in .22 seconds, whereas the second, "increase", gave 3,550,000 results in .18 seconds.

Just like the search engine, we brace ourselves for the worst with HIV/AIDS, we're habituated to hearing bad news. As the pandemic continues and effective methods for decreasing HIV infections, increasing treatment, and procuring funding seem at times as elusive as ten years ago, sometimes we need to look up once a year on AIDS day with some real intention just to see the inches gained in the sand we've been trying to get traction in.

Otherwise, even though the number of number of infections has decreased by 17% since 2001, all the World AIDS Days blur together and we're tempted to ask questions. Questions like -- has anything actually changed since the 20th World AIDS Day of 2007, when 61% of HIV infected population were women? Or from 2008 World AIDS Day? Or the first World AIDS Day 22 years ago?

Last year, on the the 21st World AIDS Day, we noted milestones like Bush's PEPFAR funding effort, and Barbara Hogan's appointment as South Africa's Health Minister. However, things change quickly in this area of public health, and this year brought both positive and negative news for PEPFAR and South Africa, two of our areas of interest.

The year started out promisingly, with Obama's inauguration and his pledge to pay even more attention to AIDS, especially for the recently increased national infections. He noted that his strategy would-

"...be based on the best available science and built on the foundation of a strong health care system"....however, he warned, "in the end, this epidemic can't be stopped by government alone, and money alone is not the answer either."

After being sworn in, Obama immediately got rid of the ban on international funding for groups that provided counseling on abortion. Condoms, an essential part of prevention, lost the evil connotation they had during the Bush administration. (The church took up the campaign when Pope Benedict XVI announced falsely in March that condoms would worsen the AIDS crisis). Obama was true to his campaigning words here. Science studies show that condoms are effective, and abstinence programs are not. Studies also show that attention to public health is central to preventing and treating infectious disease. Indeed, healthcare has been a theme of Obama's administration -- albeit to what end, we don't know. The president also recently lifted the HIV/AIDS travel ban, which has ostracized AIDS patients, something that's also been proven to undermine prevention and treatment programs.

Unfortunately, but again true to his word, Obama hasn't provided the leadership people hoped he would, even though government leadership has proven central to any successful HIV prevention and AIDS treatment program. Worse, although Obama the president-elect promised $1 billion per year in PEPFAR funding, the 2010 budget proposal contains only $366 million. The funding shortfalls have effected HIV and AIDS treatment programs, for instance eligible patients in Uganda are being turned away for lack of funds. The president's funding choices earned Obama a scathing D+ from AIDS NGOs.

Change in South Africa

In good news, South Africa's President Zuma has made several promises that show he's wised up from the time in court not long ago, when he defended himself on rape charges and said that a shower would prevent infection by HIV. Last month, Zuma promised that South Africa would vigorously address the national AIDS crisis.

Last May, when Zuma announced the reassignment of Barbara Hogan, whom he replaced with Dr. Aaron Motsoaledi, there was some concern from South Africa's public health community about the assignment, concern the Dr. Motsoaledi was inexperienced, while Hogan's work was widely praised. However public health groups have since welcomed the new minister's straightforward acknowledgments of past mistakes.

We hope South Africa's new realizations -- like that the nation's deaths from AIDS increased more than 100 percent in 11 years -- are not just a rhetorical distancing of the ANC party from former President Thabo Mbeki's and his denialism, but a real commitment to an AIDS program. Optimistically, today Zuma announced the government's intention to treat all babies and pregnant women infected with AIDS.

In other major HIV/AIDS news this year, initial reports of a successful vaccine clinical trial in Thailand brought increased public attention and then consternation to later news of the same trial. The second news release informed the world that when researchers did further analysis of the results they doubted that the benefit was statistically significant. That's the way it goes though, steps forward, and steps back. The work continues tomorrow, and for the next 364 days we'll all work towards a more upbeat World AIDS Day 2010.

For most of history, people were bent on dominating and conquering nature, clearing land, killing predators, and domesticating the wild. Now humans are determined to prevent some species from going extinct, from trees to frogs to large cats. These campaigns sometimes seem fetishized and bizarre -- wildlife foundations who implore us to mourn the death of one fuzzy, photogenic animal -- who beg us to send money so that the death of any individual animal was not "in vain". We send our heartfelt support and then fight to keep other species out, those that heedlessly invade our ecosystem as we currently know it. Humans devise management systems and models, and write up elaborate plans that look organized to any audience. As much as I heartily approve and endorse all this work -- oh, dare I say this?-- from afar, in certain fleeting moments, the efforts can look excessively anthropomorphic, sporadic, desperate, pathetic, or even futile. Who do we (yes, the odious, collective we) think we are? If we conquered nature before do we think we can undo the damage? Or do we just instinctively try to mold our ecosystem to evolving ideas or fantasies we have about nature? Why do we undermine our best efforts? What ecosphere, exactly, are we aiming for, we humans?

• Headlining, With Great Fanfare, Some Crocodile Fossils: "Darwin's finches have nothing on these crocodiles", says Science. The open-access journal ZooKeys published a monograph describing crocodile fossil finds from the Cretaceous period, including what the scientists describe as three new species. "My African crocs appeared to have had both upright, agile legs for bounding overland and a versatile tail for paddling in water", said Paul Serono, the National Geographic explorer in residence (emphasis added). (via Science in "Slideshow: Ancient Crocs With a Dog-Like Walk")

• Darwin's Mockingbirds: Scientists are analyzing DNA they've extracted from the footpads of mockingbirds brought back by Darwin. They hope to use the information to select species of mockingbirds most like the original ones, and reintroduce these species to the island of Floreana.

• Amazon Deforestation Slows? Brazil reported a record low for Amazon deforestation, the lowest it has been in 21 years. Only 7,000 sq km was destroyed between July 2008 and August 2009. However some organizations tempered any enthusiasm over Brazil's claims. Greenpeace said in a press release that its would be happy when " in 11 years time, the Amazon was being destroyed at a rate of a little less than three cities the size of Sao Paulo a year". Some people suggest the recent reduction is related to the economic recession. We previously wrote about deforestation here, here, and here.

• Modeling Deforestation and Degradation -- REDD: The journal Nature describes a deforestation modeling project aimed at "reducing emissions from deforestation and forest degradation" (REDD). Emissions from deforestation and degradation account for about one-fifth of the world's total emissions, however deforestation goals weren't included in the Kyoto Protocol because there was no reliable system for estimating CO2 emissions reduction. Scientists think that REDD is one of the cheapest ways of reducing overall emissions. If models were robust, richer countries could use the forecasts to reduce CO2 emissions, and to compensate poorer countries for minimizing biomass loss, more economical than reducing industrial emissions.

  A REDD project by Applied Systems Analysis (IIASA) uses three existing land-use models to predict future losses. Project scientists say this model is a better predictor of deforestation than estimates based on historical analysis. The model predicts higher rates of deforestation in Central African countries of the Congo Basin than historical based predictions do, because economic activity in Africa is accelerating. Therefore compensation would be relatively greater in Africa using REDD, whereas Brazil, where deforestation has been going on for years, would fare better using a historical model. However as with any model, REDD is naturally only as good as the data going in, and doesn't factor in illegal logging.

• Geo-Wiki: In order to improve deforestation models, another tool, Geo-wiki asks volunteers to help refine land cover maps by filling in knowledge about their local areas (via Nature).

• 17,000 Species, Leagues Under The Sea As the rainforests disappear, scientists involved with the Census of Marine Life released a preliminary report on a bounty of life in the sea below the reach of sunlight, including this copedpod, which I'm most enamored with.

• Scientists Make Mistakes about Skates: Species of skate may be fished to extinction because of species identification mistakes, according to research reported in Aquatic Conservation. Since the 1920's scientists thought two species of skates -- which are cartiligenous fish like rays and sharks -- were only one species. The two distinct species, the flapper skate, Dipturus intermedia and the blue skate, Dipturus flossada were grouped together and known as the common skate: Dipturus batis. The French researchers say that both species may be more endangered then previously assumed because of the taxonomic labeling mistake.

  The researchers also point out that official fisheries statistics done by French ports grouped five distinct species under only two species names. The ports survey used the counts to calculare skate decline, but more precipitous declines of some of the five species were masked in the survey. The scientists warn that similar fishing surveys may gloss over species loss in "Taxonomic Confusion and Market Mislabelling of Threatened Skates: Important Consequences for Their Conservation Status". Igle et al, Aquatic Conserv: Mar. Freshw. Ecosyst. (2009). DOI: 10.1002/aqc.1083

• Carp Invade Great Lakes: Some carp are endangered. Jullien's Golden Carp Probarbus jullieni, found in South East Asia, especially in the Mekong, is considered a threatened species. The so called naked, or scale-less carp, Gymnocypris przewalskii, is found between freshwater rivers and the saltwater Lake Qinghai in China and is also endangered. Others species of carp are not endangered, rather they endanger.

  Scientists now think that two species of "Asian Carp" have invaded the Great Lakes. The bighead carp Hypophthalmichthys nobilis and silver carp Hypophthalmichthys molitrix threaten the $7 billion dollar fishing business of the Great Lakes. These fish grow up to up to 100 pounds and eat 20% of their body weight in plankton and will wipe out native fish. The silver carp not only endangers fish, it can apparently can endanger boaters who sometimes protect themselves from injury by wearing hockey helmets on carp infested waters.

  The bighead and silver carp were imported by catfish farmer's in the 1970's to remove algae. When the fish began to take over the ecosystem, federal and state governments spent ~$10 million on electrical barriers to keep the carp out of the lakes. Based on DNA samples recently collected by scientists in the water on the lake side of the fence, the carp have crossed the fence. The Army Corps of Engineers told the New York Times that "all options are on the table" to control the fish.

• Pelican Decimated by DDT Off the Endangered Species List: The brown pelican is one of four species to be removed from the endangered species list. The US Department of Fish and Wildlife has removed bird, Pelecanus occidentalis since populations have increased. DDT decimated the species in the 1970's, but since the chemical has been less in use, the bird has had the opportunity to breed and thrive. (Hat tip to Nature News and its alliteration addled "Big Billed Bird Bounces Back".)

• Climate Change Negotiations - Like Watching Clothes Dry? In last weekend's Financial Times, Matthew Engel compared the US reluctance to combat climate change with Americans' civic battles over punitive hanging and hanging clothes on clotheslines. Turns out that when Engel moved to the US from Australia he brought his Hills Hoist with him, which provided him unique cultural insight. (The internet explains that a Hills Hoist is a rotary clothesline developed in Australia which can be mechanically raised, lowered and spun. In addition to these features, the Australian government lists the contraption as a National Treasure, prized "because it could hold four nappies on each of the four outer wires.")

  Anyway, when Engel put up his Hills Hoist he realized that the US generally disparages clothes hanging. Although his neighbors were accommodating of his family's aired laundry, Engel tells the story of one Pennsylvania woman who's battling her community in defense of her right to hang clothes -- "if my husband has a right to have guns in the house, I have a right to hang laundry", she says. Engels observes the irony of US communities forbidding homeowners from hanging their clothes outside, given that clothes dryers account for six per cent of US consumer end-use electricity consumption.

  With similar cognitive dissonance, he says, the US claims that climate change action is an important priority but stodgily backs away from any Copenhagen commitment (of course now, while keeping hopes alive). Attempting to explain the apparent clash of values, he thinks (and I'm just reporting) that although Americans define themselves with property rights and piousness, these values clashe with puritan ethics and an "unshakeable faith in technology, lingering from the 1950s."

  Acronym Required previously wrote about cognitive dissonance in "Cars, Selling Cognitive Dissonance", "Sea Change or Littoral Disaster" and many others.

Maher Still Loco on Vaccinations:

As he has for years, Bill Maher continues to spread disinformation about vaccines. Over countless news cycles Maher has infuriated doctors, public health officials, and responsible citizens with bizarre warnings about letting governments "stick a disease into your arm".

Challenged to get a word in edgewise between his fusillades about "mercury" and "diet" and natural "immunity", doctors and scientists nevertheless patiently correct his errors. They explain that a vaccine is not "a disease" but a disabled virus that looks to the immune system like a live virus or bacteria and therefore prevents infection by the actual deadly virus or bacteria¹ like polio, measles, diphtheria, or influenza.

But the talk show host persists, as is his habit. Last month, Bill "I'm also not f-king my interns" Maher baffled panelists Alec Baldwin, Chris Matthews and Maryland Governor Martin O'Malley by rehashing his concerns with vaccines. Yesterday, Maher continued with a rambling column at The Huffington Post titled "A Conversation Worth Having", saying he aimed to

"clear up a few things about my beliefs concerning the flu shot, vaccines, and health in general...I will admit, I have gone off half cocked on this issue sometimes, and often only had time on my show to explain a fraction of what needed to be explained, and for that I am sorry...I agree with my critics who say there are far more qualified people than me"

Mea culpa? Unfortunately, and spoiler alert for the 2800 word article: no. I didn't say "anyone who gets a flu shot is an idiot", Maher said, "it was twittered...my bad". Then, "vaccination is a nuanced subject, and I've never said all vaccines in all situations are bad..." Nuanced? "All vaccines"? Cagey creepy crapola -- bring it on, Maher.

Discerning Maher's Health Prescription -- When "Sometimes It's OK to Fuck with Nature"

Maher writes "I'm not a germ theory denier" and he claims "I do understand the theory of inoculation", exuding all the candor of a intelligent design proselytizer putting quotes around "the theory" of evolution. To the helpful doctor who corrects him, Maher retorts snidely "Thanks, Doc, I thought there might be a little man inside the needle. Yes, I read Microbe Hunters when I was eight." (Doesn't think the conversation is worth having?)

Cocksure and funny, Maher acts as though he's arguing about some scrutable line that any eight year old can see - you don't need to be a doctor or scientist. To the left of the line there are the OK vaccines, except, he hedges, vaccines are unproven. To the right, there are the not-OK vaccines that we should be debating, like flu vaccine. But actually, if you can't already tell, there is no line or margin, because Maher is arguing the same old run-of-the-mill anti-vaccine/medicine/science schtick you've (yawwwwnn) already heard. He allows that "sometimes it's OK to fuck with nature" and prescribe medicine, but listen to enough Maher and you realize he maligns all medicine, all vaccines.

Casting Aside Science

Sure, at first you may be confused because he mixes recognizable words into gobbledygook. Do doctors ever ask patients what they eat, he asks rhetorically? No, he answers, "and a lot can be cured with diet and a healthier lifestyle" -- then Maher adds in parentheses -- "And a lot can't [be cured]. I also understand the role of genetics and generations of artificial selection".

Despite his unassailable understanding, lets review. The risk of some diseases, like diabetes Type II, can be reduced with healthier lifestyle. Some conditions, like obesity can be prevented with diet, and losing weight concurrently reduces the risks of morbidity and mortality associated with conditions like heart disease. This isn't just semantics. Diet won't prevent crippling polio, or a flu pandemic or death of a pregnant woman, or stop a kid from succumbing to weeks of illness and a 105 degree influenza fever. And typical of Maher's machinations on science, medicine and disease, he jumps down the rabbit hole with "genetics and "generations of artificial selection". Scientists use artificial selection to breed products like corn by selecting for certain traits. Humans are not hothouse flowers, subjected to "generations of artificial selection".

How Does Maher Distinguish Himself From Dr. Beetroot?

In cajoling his audience to exercise skepticism and caution and arguing for "debate", a word that should tip anyone off to incoming falsehoods; Maher says:

"Someone needs to be representing the point of view that says the preferred way to handle flus is to have a strong immune system to begin with..."

Actually, we can think we recognize this "point of view". Take, for instance South Africa's former health minister, Dr. Manto Tshabalala-Msimang, (known derisively as Dr. Beetroot), who spent years telling South Africans to boost their immune systems against the AIDS virus with diet, beetroot and lemon.

In a familiar refrain, the South African Mbeki government insisted that Western drugs were too profit oriented and dangerous. As a result of this decision, hundreds of thousands of South Africans died from AIDS, and the dying isn't over, since infectious disease pandemics gather momentum over time. Newly elected President Zuma recently warned that the death rate from AIDS may overtake the birthrate in that country.

How is Maher's argument different than that of Tshabalala-Msimang's? Where does he draw his invisible line de-marking greedy Western medicine from essential life-saving medicine? How does this board member of the "Reason Project" (Wikipedia) dedicated to scientific and secular knowledge, identify good medicine?

How is Maher's Position Different Than A Mennonite's?

Instead of agreeing with scientists and doctors, Maher chooses to listen to Barbara Loe Fisher who he finds "extremely credible", because

"after devoting her life to studying this, she says that flu vaccines aren't proven and...points out that what we need, but do not yet have, are studies of vaccinated vs unvaccinated children."

Fisher is not a scientist or a doctor, and that's ok, anyone can educate themselves about vaccinations, eight or older. Based on her experience parenting and in public relations Fisher can certainly start a vaccination information center, appear on talk shows, testify at events like the "Vaccine Policy Analysis Collaborative: A U.S. Government Experiment in Public Engagement", and give lectures to naturopaths, chiropractors, and groups like "Body by God". Who's to say she can't?

But given that Maher says she's devoted her life to studying vaccinations, you'd think she'd understand that vaccinating some children against polio, but not others, would be medically unethical. You'd think that Maher would also see the moral quagmire.

Furthermore, unfortunately, there's lots of evidence to prove that what Fisher and Maher say is the untested theory of vaccination is flat out false. As the NYT reported in 2003:

"The last two American polio outbreaks were in Amish and Mennonite communities in 1979 and in a Christian Science school in Connecticut in 1972. Measles killed 3 students of 125 infected in a Christian Science school in 1985, and a similar-size outbreak among the Amish in 1987 and 1988 killed 2 people. In 1991, 890 cases of rubella, leading to more than a dozen deformed children, hit Amish areas."

Since then, Africans who believed rumors that vaccinations are an attempt by Westerners to spread the HIV virus or sterilize Nigerians, started a polio epidemic. The Amish also suffered polio outbreaks. Mennonites, who don't believe in vaccination but do believe in travel caused outbreaks of measles in Minnesota, then South America. Like the Amish, Mennonites don't believe in vaccinations or insurance, but do believe that hospitals should cure them for a discount, once they get sick.

How is Maher's position different then that of a Mennonite? Can we have this conversation? How does Maher square his position on vaccines with his libertarian views when people end up demanding hospital bailouts because they didn't take it upon themselves to prevent illness?

The Dredged Up "Under-reported Point of View" is Often Wrong, Concludes A Bright Person

The consequences of not vaccinating become graver and more frequent as more people refuse vaccinations. The value of vaccinations is not "debatable". Vaccinations have saved millions of lives, saved millions of dollars by keeping people out of hospitals, and boosted productivity of nations. But Maher ignores all this and calls for some cost benefit analysis, more familiar anti-science denialism.

Maher appeals to all of those who eschew facts and take solace in unpopular views.

"I'm just trying to represent an under-reported medical point of view in this country, I'm not telling a specific pregnant lady what to do...[I]t's just that mainstream media rarely interviews doctors and scientists who present an alternative point of view..."

Pregnant women and kids are most susceptible to dying from H1N1 virus. Pregnant women have decreased lung capacity that increases the threat of pneumonia, and they have decreased immunity due to their pregnancy. The reason the media doesn't interview doctors and scientists with "alternative points of view" on the subject, is because doctors and scientists agree that vaccines save lives, and that pregnant woman and parents of children shouldn't die because they've been convinced by talk show hosts to doubt the CDC, the doctors, and the scientists.

Maher's is not selling an "under-reported medical point of view", rather he's latched onto a non-medical, non-science point of view. Hmmm....why does he persist?

Bill Maher's Mainstream Media Profit Motives

Unbelievably, after flogging his point of view for years, Maher says he has no motive and expects no outcome: "[M]y audience is bright, they wouldn't refuse a flu shot because they heard me talk about it...." But his audience claps when he talks non-scientific hokum -- perhaps only because they're prompted? Either they're not thinking at all, or they're confused about science, or they're easily swayed by paranoid views, or they think they're at a gladiator show - in which case they will eventually be disappointed by the "debate." Can such folks be considered "bright" in the 21st century?

To the point, though, if Maher's especially non-bright, non-medical, non-scientific point of view weren't selling, weren't rewarded with clapping and viewers and advertising dollars, would he still be ranting on? Maher's anti-vaccination position has populist appeal that draws viewers and boosts ratings. His refutation of "mainstream media's profit motives" sells well. But lets be clear. HBO's Real Time, with millions of viewers each night, is mainstream media. What's not? Acronym Required, for instance, is not "mainstream media".

And why pick on science? Scientists are a remarkably easy target, as we noted before when John McCain chronically made fun of science research. When Maher chose to accost religion, at least 50% of Americans are quite religious, and that's a lot of potential audience members to insult. Plus, religious people can get dangerous. Other Maher campaigns have also backfired, like when Maher's remarks about military recruiting spurred one Congressman to demand that Real Time be canceled.

Considering his options then, and the groups he's already alienated, scientists make a good target. They're pretty tame, therefore easy to pick on safely, and a select target for a large potential audience, since everyone's thinking of getting the flu vaccine. Maher can perhaps equivocate about good vs. bad vaccines and fool a lot of people. So Bill Maher and his mainstream media show try to expand his audience by maligning science to become more mainstream? So they forsake scientists, but also pregnant moms and kids in the process? Is this the conversation? More or less? Bravo, talk show host!

---------------------

Photo from Wikipedia under a Creative Commons license.

¹ 11/19 Added "bacteria"

Acronym Required wrote on vaccinations previously, for instance in Vaccinations, Why the Worry? we wrote about the long history of rebellion against vaccinations. We also wrote about vaccinations here and in various posts and vaccines for specific illnesses.

Bill Maher's shenanigans have been will covered by scientists like Respectful Insolence here and here, by Pharyngula; by Aetiology here and here here and by many others.

• Progress on South Africa's New Stance on AIDS? Ten years ago, former South African president Thabo Mbeki told the National Council of Provinces that it would be "irresponsible" for the state to endorse antiretroviral drugs, noting a "large volume of scientific literature" attesting to the toxicity of ARV medicines. We've written about South Africa's HIV/AIDS denialism and obfuscation over years, when, despite international and national pressure on behalf of millions dying from AIDS, Mbeki's health policies never budged and the African National Congress (ANC) leadership failed.

  Now, President Jacob Zuma has eased concerns about his intentions for controlling the pandemic by articulating a new path for the country. He recently told the National Council of Provinces that he would fight the AIDS crisis, and warned that the "real danger that the number of deaths will soon overtake the number of births." Treatment Action Committee (TAC), hailed the new administration's stance.

  Acronym Required previously wrote about South Africa's new health minister and her stance on AIDS treatment in "New Minister of Health For South Africa. Change Afoot?"; and AIDS in South Africa in "Mbeki's AIDS Legacy and Ours", Public Health, AIDS, Mbeki, and the Media, "South Africa: Peddling Beetroot, Courting AIDS", ""Not in Paradise Anymore - AIDS in Africa - Reason for Optimism?", Zuma Dodges Corruption Charges", and others.

• When Opposition is de Rigeur: In 2004, after the publication of "Mountains Upon Mountains", Partners in Health founder Jim Yong Kim moved to the World Health Organization to lead the HIV-AIDS program, where he initiated the 3 by 5 HIV/AIDS treatment plan with a goal to treat 3 million people by 2005.

  From the time that antiretrovirals became available in the 1990's, people in Western countries like the US and countries like Brazil, that endorsed universal public health, increasingly had access to retrovirals, which made an AIDS diagnosis for those people more manageable and less often lethal.

  But there was huge opposition to treating large scale AIDS pandemics in places like sub-Saharan Africa. The various reasons people gave for not treating ranged from logistical (transport over inhospitable terrain), to patient non-compliance, to high rates of fraud, to fear of Western drugs. South Africa's example was publicized and shocking but not isolated. However, by 2004 drug prices had dropped and the tone of objectors had softened, if only slightly. Here's Kim in 2004, urging the world respond to the AIDS epidemic quickly "at its own pace", that is, at a pace comparable to the rapidly advancing viral pandemic. The 3 by 5 plan allowed 1 million people to be on treatment by 2005, and today, more than 4 million are being treated.

  "For the activists, you must hold all of our collective feet to the hottest possible fire because large organizations and the powerful have a way of finding reasons to not take action. If you don't continue to push us, we will falter."

  A good message. Jim Yong Kim is now the president of Dartmouth College.

• Problems in National Health: 17,000 kids in the U.S. Die each Year Because They Lack Insurance: John Hopkins Children's Center researchers studied data from more than 23 million children's hospitalizations in 37 states from 1988 to 2005. Compared with insured children, uninsured children faced a 60 percent increased risk of dying, the researchers found. The analysis attributed 16,787 of some 38,649 children's deaths nationwide during the period analyzed to lack of insurance.

• Polls, Spin, Memos, and the Public Option: We previously wrote about Frank Luntz, whose healthcare memo urged defeat of the public option via specific spin doctoring and tested rhetoric last July. Well, of course with Congress chewing over healthcare, Luntz has been at it again. Luntz purports to have talked to some Americans who told him they want still worse healthcare with no public option -- the "massively expensive" option he opines with false, if resonant authority. The new memo reiterates much of the old one and it contains all the same language aimed at preserving the healthcare status quo. When invited to talk shows, he says that his polling shows that Americans are "mad as hell". And Luntz isn't the only one lobbying against healthcare reform.

• Evidence Based Policy - Abstinence Funding Halted Decades After Proving Ineffective (Sometimes Time Wins): The Obama administration cut abstinence-only funding, after multiple studies showed that it doesn't work -- abstinence doesn't change sexual behavior, pregnancy, STD rates, or age of first sexual activity. Furthermore, studies showed that abstinence programs routinely dole out incorrect or incomplete information about condoms and contraception, causing confusion and misperceptions among the very vulnerable populations the programs claim to protect. (Abstinence-only doesn't work in HIV/AIDS programs either.)

  A recent Newsweek article focuses on the sudden funding decrease affecting those organizations which burgeoned during the last couple of decades because of the federal money. According to Newsweek's article, some U.S. programs like Kids Eagerly Endorsing Purity (K.E.E.P), in the South still manage to get lots of private funding, whereas other programs are at "in a race against time to keep these people in business."

Update January 24, 2010: In this post about the Tracy Kidder's book "Mountains Upon Mountains" and the MDR-TB story, we didn't talk about Haiti, where Paul Farmer began treating patients while in medical school at Harvard. There, Farmer met Ophelia Dahl, and together they started PIH with Jim Yong Kim. "Mountains Upon Mountains" tells the story of how they built the treatment facility in Haiti. The recent earthquake in Haiti is devastating and the work is not done for Haitians when the tragedy disappears from the headline news. There are many excellent agencies working in Haiti, but here's a link to the Partner's In Health page on Haiti. Remember Haiti -- even after the earthquake.

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I read Tracy Kidder's "Mountains Upon Mountains" last fall, as did many freshman college classes in the U.S. I'm not a college freshman, but I still found it a hopeful book, worth reading as antidote to ennui about the politics of healthcare or the environment, as a salve for cynicism about human nature or the media (perhaps by the end you won't need a goofy picture some fluffy, web-ubiquitous kitten), to remember where international public health was decades ago, or just because.

In Chapter 18, Kidder describes Partners in Health's (PIH) program in Peru to manage multi-drug resistance (MDR)tuberculosis (TB). By the late 1990's PIH's program, originally a trial, had decreased MDR-TB by 85%, curing the sickest patients.

The story is familiar now, perhaps legend, but still worth retelling. MDR-TB had been considered not worth treating in that patient population until PIH's persistence in Peru. Then (and now), the most successful treatment strategy was Directly Observed Treatment Short-Course (DOTS), which makes patients take first-line TB medicines under the eyes of doctor or healthcare worker, thus reducing non-compliance and risks of antibiotic resistance. While highly successful, DOTS didn't cure the MDR cases cropping up in Peru, where patients were dying regardless of medications they had or hadn't taken.

Paul Farmer and PIH's goal had always been to work towards health equity, to assure that people in poor parts of the world got comparable care to people in Boston. With MDR-TB, the PIH challenge became to convince global public health agencies, the TB community, and funders that these patients should be treated, at a time when the dominant public health paradigm dictated treating the greatest number of people with a limited pie of dollars. The PIH success in Peru helped their argument. But the expensive MDR program that PIH employed to cure patients still didn't make sense in public health circles because the cost of treating MDR-TB - to put it bluntly: didn't justify the lives saved.

PIH worked on the TB community, convincing them that the MDR protocol --"DOTS-plus"-- was technically feasible. Concurrently they worked on pharmaceutical companies and allied with NGOs to bring the drug prices down by as much as 90% on some drugs. They also worked with private funders to raise money, and by successfully coordinating these efforts, challenged the paradigm that precluded the poor from viable healthcare. As Jim Yong Kim put it, "The only time that I hear talk of shrinking resources among people like us, among academics, is when we talk about things that have to do with poor people."

It was a longer, tougher, more complicated and convoluted fight than my few sentences illustrate, or even that Kidder's skillful multi-chapter coverage details, but PIH's plan to treat MDR-TB patients more widely than in Peru worked. DOTS-plus was endorsed by public health, recognized as effective, and funded. Now people throughout the world increasingly get treated instead of being allowed to die. Their treatment decreases the spread of TB.

The challenges never end, of course, now there's the more lethal extensively drug resistant tuberculosis, XDR-TB. But, as the story shows, insistence and the persistence saves many lives.

Better than Chicago 2016: ""Who will win?", they wondered: "Morgan Tsvangirai, the Zimbabwean opposition leader; two Chinese dissidents, Hu Kia and Wei Jingsheng; Afghan: Human rights activist Seema SamarSo; Prince Ghazi bin Muhammad of Jordan; the Western-educated Islamic scholar; Eighty-year-old Vietnamese Buddhist monk Thich Quang Do; Colombian senator Piedad Cordoba?"

Obama won the Nobel Peace Prize. The reaction, needless to say, was mixed, with the Taliban, Syria and Hamas weighing in, and praises from folks like the Mandela Foundation and Desmond Tutu. And where are the photos of the Weekly Standard staff members, who cheered when Obama's entreaty to the Olympic Committee failed to bring the games to Chicago? Snapshots of them crying into their coffee cups?

We think it's all working out for the best though. Olympics in Chicago would have no doubt snared and infuriated millions of people at the O'Hare airport we know and hate. Chicago 2016 would not have been peaceful.

Nobel Prize To Push the World In a Direction We Norwegians Can Endorse

But if you're feeling like Nicholas Kristof, who thinks that perhaps a prize for Obama would be more apt at the end of his eight years, "after he has actually made peace somewhere", whereas someone else should have won this year, know that all those left out are in good company. Foreign Policy lists other deserving candidates who failed to win in the past.

One committee member said that the prize should be viewed as "support and a commitment for Obama." In a way, the Nobel Peace Prize given to Al Gore and the IPCC in 2007 was a similar statement in its overt political support for one side of the contentious arguments about whether climate change was real.

Obama, charming, said:

"Malia walked in and said, "Daddy, you won the Nobel Peace Prize, and it is Bo's birthday!" And then Sasha added, "Plus, we have a three-day weekend coming up." So it's good to have kids to keep things in perspective"

He said he doesn't see the prize as recognition for his accomplishments, rather as recognition for the goals he's set. The committee therefore rewards Obama for being very Obama...and nudges him to do more?

Plague

Earlier today Xinhuanet.com reported that a fourth pneumonic plague patient is near death and one more is in serious condition in the town of Ziketan, a remote northwestern village in Qinghai Province in the Hainan Tibetan Autonomous Prefecture. 12 people have been hospitalized and three or four have died. Chinese officials have quarantined the town of about 10,000 and are killing rats and fleas to prevent further spread of the disease. Later today Xinhaunet.com reported that officials have now effectively controlled the plague.

Pneumonic plague infects the lungs and is caused by the bacteria Yersinia pestis (Y. pestis). This bacteria also causes septicemic plague and bubonic plague -- the form of plague depends on the the route of transmission. Pneumonic plague is transmitted by aerosolized bacteria, which cause pneumonia, progressive organ failure, and often swift death if left untreated.

Because these bacteria are carried through the air in droplets, the disease can spread from humans to humans or animals to humans, and is considered highly contagious. If the infection is diagnosed quickly and antibiotics given promptly, patients will make a full recovery. The World Health Organization is working with Chinese officials and monitoring the plague outbreak.

The Center for Disease Control (CDC), has an interesting page on the history of the plague. Until Alexandre Yersin and Shibasaburo Kitasato determined the cause of the disease in 1894, many people died and many more attributed the massive deaths to the wrath of gods.

After the scientists identified the cause bacteria Yersinia pestis, people adapted to the fact that the disease spread between animals, often rats, via fleas. The mere sight of a dead rat sometimes causes people to flee their homes and towns. Plague can cycle for years between rats and fleas without infecting human populations, but inevitably, every few years an outbreak occurs. The CDC article notes that the catastrophic loss of life associated with historic plagues -- even today -- gives people a heightened fear of "the plague".

Zoonotic Disease Update

Plague is in the large group of zoonotic diseases that pass from animals to humans, or from humans to animals -- also called reverse zoonosis. In other zoonotic disease news, French scientists isolated a new group of HIV-1 from a Cameroon woman, which they're calling group P. The scientists found that this strain originated in gorillas rather than chimpanzees. The woman had recently moved to Paris from Cameroon and had tested seropositive for HIV-1 but didn't have signs of acquired autoimmune deficiency (AIDS). The researchers are tracking different strains of HIV virus, and they generally identify an unusual strain when AIDS symptoms are present in someone who tests negative for the virus. In this case the opposite situation occurred.

Although various viral load tests were positive, the researchers tested the woman's viral DNA against the known groups of HIV-1, referred to as M, N, and O, and found that whatever virus she was testing positive for didn't match these groups. The researchers then sequenced the viral genome and performed evolutionary analysis, which showed that the virus sequence was closer to a known simian immunodeficiency virus (SIV) found in gorillas, called SIVgor, than to the chimpanzee SIV from which HIV-1 groups M, N, and O derived.

Scientists who had analyzed the SIVgor virus recently found that it had the capacity to infect humans, however this is the first identified case. Scientists here knew the results of both viral testing and acquired immunodeficiency status which gave them the opportunity to identify the new strain, however; there may be other people infected with the same or similar gorilla derived viruses. Nature published the report.

Also this week, the scientists proposed in Proceedings for the National Association of Sciences (PNAS) that malaria may have originated in chimpanzees.

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Acronym Required writes frequently on infectious diseases such as malaria, H5N1, H1N1 and AIDS, and once on bats and Hanta virus.

• China Delays Censorship Software

  The New York Times reports that China will delay their rule requiring all new PCs to come installed with the Green Dam Youth Escort" censoring software that we wrote about earlier this month.

• EPA Grants California Waiver

  The Environmental Protection Agency (EPA) granted California the waiver the state has long sought which will allow it to set emissions standards that are stricter that the federal government's. We wrote about this in several posts including "Clean, Clear Air, Nothing To See Here, Drive Through Please".

• Bisphenol A in the NYT and Journalistic Fence-Sitting That Must Hurt

  Yesterday we wrote on Nicholas Kristof's NYT report about disturbing research on endocrine disruptors. We discussed what we called 50-50 science journalism, where you erode your science article by giving credit to the "other side", which could be a global warming denier, for instance, or the chemical lobby.

  Another way newspapers can practice balanced journalism is when a publication like the New York Times or the Economist or LA Times runs conflicting articles to appeal to all paying advertisers. For instance John Tierney's column in the NYT today, written by Tina Kolata, quoted Stats.org to deny the dangers of bisphenol A, an endocrine disruptor. Stats has the opposite (and incorrect) science information, which conflicts with what Kristof wrote yesterday. Thus the NYT gets 50-50 coverage, for all of those science deniers it wants as subscribers.

  Both Stats and Tierney are solidly in the science and environmental deniers camp. We wrote about John Tierney's denialism in "Scientist Columnists Sell You Short". Tierney has long expressed his devotion to bisphenol A -- "if they ever try recalling it, they'll have to pry [my Nalgene bottle] from my cold dead fingers", he wrote last year. Tierney routinely comes out against science.

  Acronym Required previously wrote about Stats in "Yotta-Yotta-Yottabytes: Content Makes Kings, Print Dies", and various posts on bisphenol A. Stats, as reported here by Sourcewatch, claims to be a "non-partisan" think tank, but they are funded by conservative sources and consistently produce reports that fly in the face of science.

• Climate Bill's Mixed Reports

  The Waxman-Markey Climate Bill passed last week by Congress received mixed reports on its predicted effectiveness. The National Resource Defense Fund sent an email screaming euphorically, "Well, we did it! And we did it because millions of people like you made their voices heard on Capitol Hill."

  On the other hand, Clive Crook, who we previously highlighted for his climate denialism, had an opposing opinion. Read his "The Steamrollers of Climate Science", for instance, in which he wrote that the IPCC report on climate change was biased, and what the world needed was some opinions from people affiliated with the Marshall Institute, Fraser Institute, and Competitive Enterprise Institute (CEI) (all funded by ExxonMobil). You'd think from that you'd know where he stood.

  But Crook, climate science denier last time we looked, said yesterday that the President was being too weak on climate change. Accompanied by a cartoon of the president ripping open a Superman t-shirt to reveal a cute little Hello Kitty figure, Crook said:

  "The cap-and-trade bill is a travesty. Its net effect on short- to medium-term carbon emissions will be small to none. This is by design: a law that really made a difference would make energy dearer, hurt consumers and force an economic restructuring that would be painful for many industries and their workers. Congress cannot contemplate those effects. So the Waxman-Markey bill, while going through the complex motions of creating a carbon abatement regime, takes care to neutralise itself."

  Conservatives argue that the climate bill will negatively effect the economy for a very small pay-off, whereas some environmentalists argue that the cap-and-trade regime proposed will not work, that there a giant loopholes, and that coal gets too much of a boost from the legislation.

  RealClimate, for its part, is taking a break, a little bummed out about the Groundhog Day aspect of the internet, where you explain the science that all the deniers deny, then they pop-up again. How true, though more a game of Whac-A-Mole than Groundhog Day perhaps. Tenacity wins.

  Joseph Romm of Climate Progress weighs in favorably on the bill.

Nicholas Kristof wrote about endocrine disruptors in his column this weekend. He cites some of the evidence for disturbances in sexual development -- "bizarre deformities in water animals" -- and accumulating evidence of the same disturbances occurring in humans.

Acronym Required first wrote about endocrine disruptors back in 2005, with Plastic Bottles- Protecting Your Baby, by the ACC". Hundreds of studies in the past 20 years have documented disturbing effects of endocrine disruptors, which are widely used in industry and agriculture to make the food you eat, the containers you eat out of, and the products that surround you as you sit and read this post. Endocrine disruptors act like hormones to effect physiological actions in species from fishes to humans. Here's some of the evidence Kristof cites from the research literature on different chemicals:

• "Frogs, salamanders and other amphibians began to sprout extra legs."

• "In heavily polluted Lake Apopka, one of the largest lakes in Florida, male alligators developed stunted genitals."

• Researchers found in 2003 that "in the Potomac watershed near Washington, male smallmouth bass have rapidly transformed into "intersex fish" that display female characteristics." Today 80% of these male fish lay eggs.

• Scientists are concerned with "large increases in numbers of genital deformities among newborn boys."

• "7 percent of boys are now born with undescended testicles, although this often self-corrects over time."

• "And up to 1 percent of boys in the United States are now born with hypospadias, in which the urethra exits the penis improperly, such as at the base rather than the tip."

• "DES, a synthetic estrogen given to many pregnant women from the 1930s to the 1970s to prevent miscarriages, caused abnormalities in the children."

• "evidence from both humans and monkeys [suggests] that endometriosis, a gynecological disorder, is linked to exposure to endocrine disruptors."

• "Researchers also suspect that the disruptors can cause early puberty in girls."

"research has also tied endocrine disruptors to obesity, insulin resistance and diabetes, in both animals and humans."

• "mice exposed in utero even to low doses of endocrine disruptors appear normal at first but develop excess abdominal body fat as adults."

• Kristof notes a recent statement from the Endocrine Society. The group of scientists says: "In this first Scientific Statement of The Endocrine Society, we present the evidence that endocrine disruptors have effects on male and female reproduction, breast development and cancer, prostate cancer, neuroendocrinology, thyroid, metabolism and obesity, and cardiovascular endocrinology."

• Kristof quoted Dr. Ted Schettler of the Science and Environmental Health Network, who said, "'this can influence brain development, sperm counts or susceptibility to cancer, even where the animal at birth seems perfectly normal."'

There's a lot more evidence showing that chemical disruptors produce widespread harm over the environment to produce abnormal reactions. As one John Hopkins scientist told Kristoff: "It's scary, very scary."

But in a completely curious turn, halfway through the article, Kristof capitulates to the winds of "50-50 science journalism". Here's how "50-50 science journalism" works.

1. Accumulate your evidence.
2. Make a strong case for your point, citing the evidence.
3. Then abruptly cripple your whole point, smash it across the knees, by writing a one or two statements for the "other side", thus appeasing some readers and advertisers.

Kristof writes: "The scientific case is still far from proven, as chemical companies emphasize, and the uncertainties for humans are vast." To be fair, Kristof's reference to the "other side" could be considered merely a polite and politic mention. "Vast uncertainty" for humans could mean anything. But even at best this doesn't line up with the rest of his article and all the evidence he cites. What about his lists of studies?

Scientists are "connecting the dots" he writes. I know this may sound trifling but scientists are well into the data. It's only recently that the public is realizing that this problem is real -- a realization that's more substantial, quite un-dot-like. Some journalists are farther behind, but again, the evidence is accumulating at a brisk pace.

My small reservations with his article aside, Kristof often takes on controversial issues, especially in international development, that are easy for the mainstream press to ignore. While coverage of bisphenol A is surprisingly robust, now that states and cities have initiated legislation restricting its use, the larger questions of pervasive chemical use without regulation remain largely ignored. Importantly, this topic has been very easy for federal agencies to ignore. Therefore, it's great to see coverage of endocrine receptors by an influential New York Times journalist who will help inform the public, who will in turn demand that government act more aggressively on chemical oversight.

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Acronym Required writes frequently on journalism that remains faithful to all sides of science policy issues despite the evidence, for instance Climate Change: Fueling the "Debate", "Science Editors Sell You Short", and Phthalates and Bisphenol A: Media and Politics

• Spies, East and West

  Beijing will recruit 10,000 "internet volunteers" to monitor "harmful" websites and content, according to the city's municipal authority information office, via Financial Times.

  The US too, is expanding a program to recruit spies among first and second generation college students. According to the Chronicle of Higher Education, the program started as a pilot program, the Pat Roberts Intelligence Scholars Program in 2004. Kansas Republican Pat Roberts initiated the program after September 11, 2001 following urging by a University of Kansas anthropology professor. Professor Felix Moos had shopped the program around for years, arguing that the federal government should provide scholarships for people to attend colleges and learn languages, technical skills, culture and anthropology in order to work for the CIA. The Obama administration would keep the identity of the spies-in-training a secret.

  The program has its critics. According to interviews by the Chronicle of Higher Education in 2005, some professors were concerned about the Pat Roberts program and the anonymity of the participants which the government could leverage to essentially spy on professors, as they did during the Cold War. Others argue that the program could instill distrust of all researchers from foreign governments. Still others were concerned about the ethics of mixing spying with academia.

• East is East, Thanks to the West

  In other government spy news, the Wall Street Journal writes that Iran is using technology made by Siemens AG and Nokia Corp. to censor internet communications. The technology allows Iranian authorities to block and filter sites and perform deep packet inspection to monitor individuals and control information. Much of the Iranian system operates through a single node at the Telecommunication Infrastructure Co., part of the government telecom monopoly.

  Iran controls communications any way it can, according to the WSJ, filtering international connections go through a single gateway, blocking users in the country from accessing millions of sites in the last few years, and at times requiring bloggers to obtain licenses from the government.

  Under normal circumstances, all the west's technology helps Iran control the population. And periodically, there are more turbulent times like these, when Iran is "now drilling into what the population is trying to say", Bradley Anstis, director of technical strategy with Marshal8e6 Inc. told the WSJ.....Because if an uprising happens on your dictatorial watch and you don't have the wherewithal to look outside the window, then just -- use Windows?

"Flashlights of Our Own"

I've never been persuaded by glib declarations about technology's capabilities to further, deepen, advance, or promote democracy. The internet emerged to find itself embraced by early adapters who would burden it with such imaginary powers -- Free the people from oppressive governments, bureaucracy, and oppression! Ten years later it was preposterously "a collection of tubes", to some, but in those early, headier times it was known by its proper name, the "Internet", and bequeathed with expectations that would fit a newborn king. Just as preposterous in retrospect, but such euphoria is typical of early technology adapters for whom new tools present endless possibilities before the inevitably slower but deeper resources of government and industry upend such temporary power imbalances.

Thirteen years ago, David Brin wrote optimistically about the spy society, and eloquently: "Can we stand living our lives exposed to scrutiny ... our secrets laid out in the open ... if in return we get flashlights of our own, that we can shine on the arrogant and strong?". But it usually works out that strong and arrogant control the resources and the opaque legal cover to build and control powerful data mining tools (for instance), while we hunt around for a couple of D batteries to peer our way into the dark with a flashlight.

The internet is now thought of more realistically, just as a wrench is a wrench, not a "Wrench", or radio is radio, not "Radio". Extraordinarily useful and life changing, but not a spontaneous force for good. However there will always be faithful technocrats who claim that technology will accomplish broad feats as "improving healthcare" or making government more transparent. I am also fairly skeptical of these claims. "Transparency" that involves dumping data onto the internet will be meted out by officials with the same vigor they reveal analogue documents, and the scads of data will be sought after by citizens with their same limited enthusiasm.

Ubiquitous cameras mounted in public places, for instance, sometimes come in handy but don't come close to demonstrating the benevolent use of technology by society, that was once claimed. Criminals only too quickly develop cunning ways to outwit such schemes. Government and corporate power of course trumps citizens' ability to oversee the overseers.

We Film Them and They Film Us and For Just A Moment No One Knows Who's Who

Though I am dubious about the claims of zealous technophiles, these doubts are periodically challenged when occasionally I see technology used in a way that hints to the potential of the evangelists. The movie Burma VJ, a docudrama that's been playing around the world for the last couple of months, is one such example.

Burma VJ splices live video footage from the 2007 uprising led by monks, with dramatized film of related events like the coordination of the video jocks (VJs) covering the protests. Starting in August and moving through September of that year, thousands of monks and citizens marched against the governance of the military junta of Myanmar, until government brutally cracked down on the protesters by all means possible. The junta dispersed (sometimes withspray (perhaps insecticide)), detained, tortured and sometimes killed protestors, monks, and videographers. A Japanese photographer was fatally shot. The VJs for Democratic Voice of Burma filmed it all -- the initial protests, the tension, the unrest, the violence, the exhilaration and hope for better life, and the ruthless snuffing out of that hope.

The video journalists and the ubiquitous secret police secretly videoed each other for a while, before the junta, armed with more guns and the unquenchable drive for absolute power, wrested control of the rising discontent. Some members of Democratic Voice of Burma are being held in prison today, some have fled to Thailand, and a couple of the luckier individuals are traveling around giving talks about the movie Burma VJ. The 2007 uprising was subdued just as quickly by the junta as during the last generation's protests. Burma VJ presents powerful political commentary on the Burmese state, and current events in the country help highlight the awful straits of Burma's citizens.¹

Since the uprising two years ago, the government remains in control, drawing oil revenues from the pipeline and clamping down on perceived threats. The trial of Aung San Suu Kyi, following the incursion of the supposedly out-of-shape, asthmatic, diabetic American who the government claims swam 1.2 miles with makeshift flippers and 60 items in a pack, including a Mormon book and robes, is the latest charade.

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¹ My only qualm with the movie is the dramatization. I don't consider myself a documentary "purist", but couldn't write non-fiction without the strong believe that consciously mixing facts with fiction isn't the best approach to presenting problems as believable. Admittedly, there's persuasive power in the director's technique, and no doubt the movie wouldn't have the power it does without the devised storyline. Nevertheless, its unsettling both that some of the scenes are re-enacted and that so many film reviewers seem to miss this fact.

Despite the paucity of news, people traveling to Burma bring back interesting news and projects.

Public Health and the Culture Wars

In our last post, we acknowledged that the GOP attempted to derail economic stimulus efforts by studding the recovery package conversation with fear-mongering blather about STDs and condoms. This is an old trick to peddle failed policies. The Republicans tax-cut centric governance style doesn't work, but when they add rhetoric about promiscuity and condoms, people for some reason go all woozy and vote GOP. With such a recipe for success why change?

Just as evolution keeps bumping up against religion when fundamentalists gate crash the classroom, family planning based on science, statistics, and good public policy will always encounter obfuscatory politicians spurred by religious advocates trying to portray serious conversation as lasciviousness to be resolved by morality talk.

The CDC's annual STD report released January 13th indicated that STD infections were rising in the US. That might be expected. The former president George W. Bush removed birth control education from aid programs in favor of abstinence information doled out by religious organizations. During that dark time, the Republican party corralled the vote of church goers by regaling them with grisly horror stories about the godless amorality and depravity of birth control. The GOP honed this strategy over decades before it began to bear fruit during the Reagan era. It reached a apex (I hope) during the Bush administration.

Still In the 80's?

I was reminded of how long ago the condom tirades started when I came across an editorial from a May, 1987 issue of U.S. News and World Report. The story also reminded me that this wasn't always a Republican strategy.

In 1987 the AIDS crisis was a growing public health threat. New York city Mayor Koch wanted to run 30 second TV spots, print ads, and radio announcement to encourage heterosexual women to use condoms. At that time half a million people in NYC were infected with HIV.

Harold Evans, a contributing editor of US News and World Report reported in "A Necessary Offense", that ABC and CBS refused to run the ads, which Brooklyn Democratic Councilman Noach Dear called "'disgusting'". The stations also opposed the advocacy of Surgeon General Koop, who also recommended using condoms in addition to abstinence and monogamy.

In 1987 religious leaders and network executives protested that advocating condoms would promote promiscuity. However as the US pursued this policy, Denmark and Sweden were publicly promoting condom use, as was Britain. And as Evans wrote on the European policies: "no widespread disorder is reported."

Beyond Fundamentalism

Evans wrote in US News & World Report, "birth control is not only accepted by the majority; it is rightly advocated..." Furthermore, in the context of the AIDS epidemic:

"Minorities cannot reasonably expect to prevail when their scruples threaten not just the right of free expression of a majority but the very existence of majority and minority together."

Twenty-two years later, television stations still "parade" morals with an even steeper gradient of "ultimate hypocrisy". TV programming has of course advanced in licentiousness beyond the "sexual soaps" and "exploitative product marketing" of the 1980's, and the internet takes off where television leaves off. The initial Republican strategy to win votes based on morality plays, once so successful, most recently begot devastating GOP seat losses. Meanwhile, the banking fiasco, health care, climate change and job losses -- all real problems having nothing to do with condoms -- paralyze the legislature. Despite their crushing losses though, some GOP politicians still resort to this cheaper populist strategy in times when clear headed leadership is so critical.

The US touts the superiority of its advanced technology. But if the nation is to be effective against pockets of global fundamentalism as well as the current global economic crisis, politicians best continue to elevate the tenor of their argument beyond reflexive smut and groveling to thoughtful negotiations and leadership. "Tax-cutting" (bolstered by cultural fear mongering) confuses consumer "choice" with democratic freedom and grinds the country down.

The Presidential Universe of Me

Another year passed and today's World AIDS Day finds us with many of the same struggles as last year. However there's also been progress.

For instance this year brought funding for Bush's PEPFAR program for drugs and prevention. Bush had said at the ceremony for H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008:

"...I wish every single America '[sic]' could have seen the tens of thousands of people who lined the streets during our visit, and they were cheering and waving American flags in gratitude to the generosity of the American people..."

We all wish we could have seen it. Instead Bush will have to settle for some crowd appreciation today from President-elect Obama, who congratulated Bush for his efforts on PEPFAR. In response, first Lady Laura Bush said: "That's sweet, so sweet." Bush had been having a blue day, saying in various interviews that he was "unprepared" for war, (but noting there was no war on during his campaign.), that he was "sorry it's [the economic meltdown] happening", and that "some people voted for Barack Obama because of me." Some in the media called this an apology.

On the AIDS front, Bush established PEPFAR, but also ignored family planning which is effective at preventing the virus from spreading. The Obama administration, ever diplomatic, intends to loosen the Bush administrations restrictions on funding, which dictated abstinence only teachings for grantees.

From Failures, New Directions

In other AIDS news this year, the major vaccine initiative came up negative in clinical trials, motivating HIV/ADS programs re-focused their goals.

And in very optimistic developments, the South African interim government chose Barbara Hogan to work as Minister of Health until the new government takes office. See: "New Minister of Health For South Africa. Change Afoot?" Hogan recognizes both the crisis of AIDS as well as underlying issues such as public health infrastructure. Today, Hogan led a minute of silence in South Africa.

YAY!

It's a new day.

"...His triumph was decisive and sweeping, because he saw what is wrong with this country: the utter failure of government to protect its citizens. He offered a government that does not try to solve every problem but will do those things beyond the power of individual citizens: to regulate the economy fairly, keep the air clean and the food safe, ensure that the sick have access to health care, and educate children to compete in a globalized world..." (NYT)¹

Yes, there's work to do. Yes, it will be difficult. But today we recognize how much America's just accomplished.

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¹Obama won despite warnings about possible GOP ballot fraud stemming from information dribbling out of the Ohio trial concerning 2004 Ohio ballot fraud. In the latest episode, Michael Connell, a consultant whose firm has been accused of computer manipulation, denied knowing anything about GOP rigging the 2004 Ohio election results. Connell works for Randy Cole. Cole owns 15 companies that work simultaneously on GOP election campaigns (Bush/Cheney 2000/2004, McCain 2008, many others), anti-Abortion groups and churches, GOP mass mailings, government contracts, etc. Stephen Spoonamore, a key witness in the trial brings the allegations, explains in a multi-part series starting here.

Several recent studies measuring biodiversity have found significant losses due to global warming and human activity. We know of course, that this has been happening for a while, but its good to be reminded of the path we're headed down. The scale of these species losses is challenging to fathom, and will be challenging to stem.

• In the latest issue of Proceedings of the National Academy of Sciences (PNAS), a group of Stanford scientists found significant amphibian decline in Yellowstone National Park. The researchers found that the number of permanently dry ponds in the northern end of the park increased 4-fold due to changes in the park including rises in annual temperature and decreases in precipitation and snow packs. McMenamin et al found in "Climatic change and wetland desiccation cause amphibian decline in Yellowstone National Park" (doi: 10.1073/pnas.0809090105) that three amphibian species suffered significant declines in numbers since the 1990's. Ambystoma tigrinu decreased by 50%, Bufo boreas decreased by 68%, Pseudacris triseriata; and Rana luteiventris decreased by 75%. The numbers of a fourth species did not decrease -- Bufo boreas however, the scientists found only eggs or juveniles of that endangered species.


• In another PNAS article scientists from Boston University and Harvard found that 27% of the species documented by Thoreau in his studies of Walden Pond in Concord Massachusetts in the 1850's are now gone. The article "Phylogenetic patterns of species loss in Thoreau's woods are driven by climate change" (doi: 10.1073/pnas.0806446105) Another 36% were found in low numbers. The temperatures in Concord rose 4 degress Fahrenheit during that time.


• In the UK, the Department for Agriculture, Food and Rural Affairs found that the number of "breeding pairs of farmland birds" is down 62% due to changes in agricultural processes including the use of chemicals and the decrease in mixed farming. Some species have decreased by more than 85%, and the several are now extinct.

Biodiversity is important for many reasons, some of which are documented in the book: "Sustaining Life: How Human Health Depends on Biodiversity". Eric Chiverian and Aaron Bernstein edit the book, with contributions by 100 scientists. The book takes the perspective that losing species will impact humans in many ways, including incidence of infectious disease, medical research, and food supplies.

More Money for PEPFAR

Last week George Bush signed into law a bill to increase global HIV/AID, tuberculosis and malaria funding. The bill had been delayed while the Senate negotiated aspects of the funding, questions like how much would be allocated to drugs, versus infection prevention. After legislative deliberation and compromise, the House approved the bill and the president signed it last week. H.R. 5501, known as the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, sets out to expand the President's Emergency Plan for AIDS Relief (PEPFAR) by increasing funding to $48 billion dollars for the three diseases and some miscellaneous appropriations. Further deliberations will determine whether the Act is fully funded.

In his remarks at the ceremony Bush said "Laura and I saw the hope on our trip to Africa. I wish every single America '[sic]' could have seen the tens of thousands of people who lined the streets during our visit, and they were cheering and waving American flags in gratitude to the generosity of the American people." (Bush made the same statement after visiting Ghana and four other African countries earlier this year.) He continued that he thought it "important for our fellow citizens to understand that PEPFAR is saving lives...showing the good heart of our nation...earn[ing] us respect and thanks around the world."

US HIV Infections

In other HIV/AIDS news, the Centers for Disease Control and Prevention released rates of infection information, based on revised methods used to determine time of HIV infection more accurately. As a result the CDC reports greater numbers of HIV infections in the US than previously reported. Previous data showed that 40,000 new infections occurred in the US every year, now the CDC has adjusted that number up to between 55,000 - 58,500 new cases each year. The full CDC report by Hall et al, "Estimation of HIV Incidence in the United States", is published in JAMA's August 6th issue. The CDC announced the news ahead of the international AIDS conference that started today in Mexico City. Funding for HIV/AIDS prevention has reportedly fallen relative to inflation.

Erstwhile Panda Diplomacy?

In an article on China's panda diplomacy last week, the Financial Times included a photo of Japan's famed Ling Ling surrounded by flowers and bamboo shoots. Japan's beloved panda, a 16 year resident of Tokyo's Ueno Zoo, had died of kidney and heart failure and the debate in Japan surrounded how Ling Ling would be replaced. Various Japanese officials expressed reservations about Chinese President Yu's offer to replace the panda with two new ones, especially when the $1 million rental fee was revealed. ("Panda diplomacy loses charm amid Sino-Japanese mistrust", May 12th, Financial Times).

Critics advised the Japanese government not to trust the panda overtures in light of China's environmental problems, food-safety, natural resource claims, and anti-Japanese sentiment. Panda proponents on the other hand, like the head of the Ueno Zoo, pointed out the benefits and reasonableness of Yu's offer - as he put it to the Financial Times - "'It is not like renting videos"'.

Pandas (Ailuropoda melanoleuca) are an endangered species in the Ursidae family. So called panda diplomacy has been around since Chinese emperors were giving pandas to governments but China revived the practice by presenting President Nixon with two pandas. When China started charging rent for pandas a successful suit from the World Wildlife Fund demanded that US government payments be channeled to increasing panda populations in the wild.

The pandas' appeal to zoo visitors is unambiguous, profitable, and beneficial to the panda. But although the Chinese has long been supplying pandas to Japan, the current Japan/China dilemma lead some international press to wonder whether Ling Ling's death marked the end of a more optimistic era between the two countries.

Thumbs Up...Panda's Alive and Well

When the earthquake struck Sichuan province people were relieved to hear the news that the giant pandas were safe at China's Chengdu Research Base of Giant Panda Breeding. At another panda reserve even closer to the earthquake epicenter, the Wolong Nature Reserve, the plight of the pandas and nearby villagers was unknown for days. Those in the global panda community who had visited the center and spent time with the Wolong pandas and their caretakers became increasingly worried.

Finally bad and good news came. Some of the villages around the reserve did not fare well, homes were destroyed and people perished when the 7.9 temblor struck the mountainous region.

The pandas at the Wolong reserve were OK, despite the massive earthquake and ongoing "aftershocks" that surpassed the average Chicago "earthquake". A Chinese news article (china.org) reported that a group of American and British tourists stranded at the Wolong panda reserve when the earthquake hit were also safe after being helped by a resourceful local army, kind villagers, humor, television and traditional Tibetan dancing (the latter, actually seems like a standard for Chinese Panda tours advertised on the web).

Panda diplomacy seems alive and well.

On to Polar Bear Diplomacy?

The endangered pandas seem to have it lucky compared to polar bears (Ursus maritimus). Also in the Ursidae family, polar bears were recently designated by the US Fish and Wildlife service as "threatened". The agency lists a species as threatened if they're likely to become "endangered" and the melting Arctic makes this so. The new label was welcomed by some and criticized by others who thought the polar bear should be listed as "endangered". The LA Times reported this week that small towns like Churchill, Manitoba will see an influx of tourists because of the government's new polar bear status. Although Canada hasn't turned official attention to the polar bears, the U.S. designation will increase awareness.

Tiny Species Diplomacy?

Most threatened or endangered species (Urrr..so ignored) emerge not fuzzy, cute, or mammal -- to their peril. Many are not even large enough to see and these more discreet species will just disappear.

A report released by the Zoological Society of London (ZSL)called the Living Planet Index, produced by the ZSL, the World Wildlife Fund, and the Global Footprint Network, tracked 4,000 populations of 1,500 species over 35 years. The census found that by 2005 the populations had decreased by a third, a decline "unprecedented since the extinction of the dinosaurs".

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The Myanmar Effect

"'A Catastrophe Within A Catastrophe'". That's how French Foreign Minister Bernard Kouchner described the "junta's uncooperativeness", after Cyclone Nargis devastated the Burmese city of Rangoon and the Irrawaddy Delta last week. The political struggles between the obstinate Myanmar military junta and international aid groups and governments trying to help Burma dominate the news. The German paper Spiegel shows a map of areas submerged in the storm earlier this week. The Guardian spoke to Mark Canning, ambassador to Britain, who warned that "authoritative estimates of the numbers of dead and missing ranged between 63,000 and 100,000, and up to 1.9 million were now vulnerable to water-borne disease, hunger and lack of drinkable water. 'So you can do the maths and you will see how quickly this thing can get larger'".

The International Red Cross and other agencies report that there aid is getting through to people who need it --a statement that will encourage donors -- but if that is remotely true, the aid is stretched very thin. The junta has confiscated food and equipment from the UN World Food Programme, refused to grant visas to aid workers, and said that it will only accept cash and material aid, not labor. The Guardian quoted the US ambassador to Thailand, Eric John, who noted in a somewhat awkward analogy that food without distribution capabilities would be like "dropping a lot of orchestral instruments on the ground and expecting a symphony to come out of it."

Let Them Eat Rotting Rice

In Burma, equipment and tools are forever scarce, as are all other resources. The military junta takes food from villagers even on "good" days, that is, when the government is merely tyrannical, incompetent and brutal but not faced with the aftermath of a massive cyclone that has ripped through a mangrove-stripped delta of rice paddies, leaving in its path face-down floating bodies and individuals desperately searching the rubble for their kin. Given the everyday actions of the junta, it should be no surprise that the government confiscates international food sent for Nargis victims -- that's just what they do. Nor should it surprise us that the government isn't ashamed to dole out supplies with the names of generals written on boxes -- before news cameras -- in some twisted "propaganda exercise", as the International Herald Tribune called it.

The military junta's political shenanigans are to be expected.The rulers are by all accounts paranoid as well as brutal, tenaciously controlling the population via the only methods they know, violence and manipulation. The Free Burma Rangers ¹, a group profiled here by The Economist, lists the junta's habitual human violations, offenses that often target minority groups like the Karen. The group accuses the military of everything from stealing supplies to burning villagers out of their villages, to forcing unpaid villagers to clear land, build roads, and walk in front of bulldozers clearing land-mined areas.

Always wrangling to increase its power, the Myanmar military relentlessly pursues its goals, even as citizens are left struggling in the wake of the cyclone without water, food or medicine. The government insisted on holding a referendum to increase its power yesterday, and the military spent considerable effort coercing, forcing and bribing people to vote "yes". With mind blowing cynicism, the leaders had their pictures snapped with their fancy-dressed wives, casting their votes for what all outsiders call a "sham" election, while hundreds of thousands of "people with almost no clothes battl[e] it out to survive" -- as one Indian pilot reported on the situation after he flew an aid sortie and traveled through the Irrawaddy Delta.

China, Thailand and India have the most potential for nudging the junta towards accepting responsibility but it's unclear how much sway these governments hold. China has the closest economic ties to Burma apparently, but what incentive it has to mediate? It's own abuse of Tibetans and minorities and its interest in Burma's resources, not to mention its habit of not "interfering", leaves us skeptical. India reports sporadically about its stance on the situation, while Burma's neighbor Thailand, for its part, will send a diplomatic team to Myanmar. Thailand was obviously disturbed to see media films showing Thailand's aid boxes plastered over with labels indicating they were gifts from the junta's generals.

What the junta is actually giving in aid, the Associated Press reports is "minuscule rations of rice and oil", in some places one cup of rice per day per family. AP says many people are simply "clustered on roadsides hoping for handouts," and that desperate pleas -- "[t]he words "'Help us!'" [written] in chalk on the side of one home", are evidence of the level of despair.

Aid First?

Disasters such as Cyclone Nargis exaggerate and bring into stark relief dysfunctional politics. They also present a quandary for international communities. A few years ago, Acronym Required wrote about the Global Fund withdrawing its AIDS program in Burma due to difficulties working with the junta. At the time we commented on the conflicted ideas about providing aid to the repressed citizens of brutal regimes. The AIDS crisis in Burma is serious and any country's bad governance will make a public health or natural disaster recovery infinitely more dire. As we've often documented, politics can worsen the death toll of AIDS or avian flu pandemic, an earthquake, cyclone or tsunami.

The world has experienced enough natural disasters in the past couple of years to know the difficulty of getting help to stricken populations. In the U.S., the government was challenged to evacuate survivors swiftly enough and to deliver aid and essentials in a timely way after Hurricane Katrina. Rescue and supply delivery is increasingly daunting in remote locations of the world, like SE Asia where the tsunami victims were hard to reach, and during the Kashmir earthquake. And in these situations the affected countries welcomed aid. ²

The international community is forever torn because there is no good answer. Try to support the citizens in spite of the government? Or condemn and punish the government, which further increases the suffering of the people? The current situation in Burma intensifies the unforgiving choices of this dilemma.

Given the Myanmar junta's treatment of the country's people, its hard not to advocate political change. But that's problematic, since governments around the world acknowledge that the Burmese in the stricken areas are in dire need of the most basic necessities now, not "democracy".

Barbara Bush, who back in 2007 advised that the US would impose sanctions on the Myanmar military government if it did not moving toward democracy "within the next couple of days", used the publicity of last weeks' cyclone to reiterate her displeasure with the military junta. The move was widely criticized by 'those in the aid community who know better', since it could only increase the paranoia of the highly paranoid holed-up-in-the-middle-of-the-jungle junta. Yet is restraining from beating people over the head when they say "no" such a challenging notion that it's only available to those in the aid community? You'd think the emerging White House diplomat would carry some insight about this from her second grade teacher experience, or her experience listening to why the US denied aid from Cuba during Hurricane Katrina, or even because her diplomatic threats to Myanmar never motivated the junta to budge before. You'd think she'd deliver a more nuanced diplomatic entreaty. Now apparently, Mrs. Bush seems to have backed off and Secretary Rice is left to insist that Burma Aid Is About Saving Lives, Not About Politics.

Of course, the White House always sends mixed messages. While Mrs. Bush lectured Myanmar from the podium in the past few years and the Bush administration imposed sanctions, for instance by cutting off the bank accounts of the junta, companies like Chevron provide a lifeline to the regime . Chevron runs a gas line through the country that is reportedly aggressively guarded by the junta.

"Tear Down the Bamboo Curtain"

So wrote the Financial Times last fall, and The Australian today. As if the western nations could just summon some erstwhile off-duty troops to parachute into Myanmar, China's neighbor and ally, to take care of this troublesome situation. The press loves to chant a rallying cry for "freedom", and "democracy", and no doubt could not restrain itself from referencing what is now relived in popular dream-talk as Reagan's great coup: the tearing down of the wall. It's the business of news to engage fantasies and so these headlines are relentlessly fantastic.

Reporters ask questions like: "Could there be a silver lining to the cyclone's clouds?" Time magazine wrote hopefully, "for decades, outsiders have searched for a way to pry open Burma's secretive regime". As if this is some natural evolution of government, when actually China, Russia and a host of other countries prove that power may be more instinctively and securely amassed via non-democratic and brutish governance. And so, spooked but with aid pouring in, after 40 years, Myanmar hunkers down to give its citizens and the world, more of the same. Tons of high-energy biscuits energy bars can go a long way in a junta that was days ago 'reduced' to stealing rice from villagers.

The Myanmar junta is of course defiant in the face of the international democracy criers, defending its own deadly actions by saying that the US government's response to Katrina was also slow. Seeing the same shaky (optimistic?) parallel, a dean from the University of Vermont, in an editorial for the Daily Times of Pakistan, offered: "This may also be a time for alerting the world to the grave inequalities in the country, just as Katrina was a wake-up call for the world to see the plight of impoverished African-Americans in Louisiana." Ah, silver linings.

It's hard to imagine that there would be "sides" in the midst of such a disaster, or that politicians would take the opportunity to push political points of view, but of course they do, even in the enlightened western democracies. In the Financial Times yesterday, Christopher Caldwell from the Weekly Standard took the opportunity to reconstruct the events of the Katrina aftermath altogether, with the truth defying statement: "that the US failed in part because it was too constitutional, too deferential to the prerogatives of the state of Louisiana, is not something anyone remembers or cares about any more." ("Disasters and Dictatorships"). "Too constitutional" -- that's Orwellian.

While countries like the US and France now try to muffle their instinctive calls for democracy, other countries will take a different lesson from the cyclone and in the US commentators will frame the disaster for their own ends. If nothing else, attempts to shape and rewrite history are universal.

Hopefully, the Myanmar military junta, weakened to the point that is convinced that it will lose control by letting aid workers in, will come to its senses and realize that in it's own best interests to save some of its people.

In the meantime, to help with aid efforts, various groups are accepting donations for Burma. Google gave a million dollars in matching aid (updated 05-17) and Doctors Without Borders, Unicef , and many others.

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¹This group lists itself as a "multi-ethnic humanitarian service movement".

²With the exception of India which initially rejected international help after the tsunami.

Acronym Required has published several articles on Hurricane Katrina and FEMA and AIDS and Burma.

Can market solutions to an intractable public health problem like AIDS work? Can paying people for intrinsic choices motivate better choices?

AIDS, Malaria and Public Health

Public health requires persistence and creative solutions. Public health is tenuous, and a mutation in a virus responsible for avian flu or a malaria parasite that can drastically change the course of a disease -- change who gets infected, where, and how.

Many other changes, in politics, economics, leadership, geopolitical stability, funding, even weather can impact progress treating and preventing diseases. Technology also changes the course of disease, although talk about technology advances sometimes provides more promise than the actual technology once it comes to fruition. In the fight against AIDS, for instance, promises of vaccines trumped promises of retroviral treatment for all or prevention. It was as if public health gave up on any solution accept a vaccine.

It's morbid to think there may never be a silver bullet for the HIV/AIDS crisis, but its also damaging to over-promise a technical solution like the vaccine that's so speculative. Despite global discouragement about the AIDS vaccine's recent setback, there are always optimistic moments, like ten years ago when education and prevention through condom use and social marketing was the crux of HIV/AIDS fight.

AIDS Long Road

The AIDS crisis seems so untenable however, that its understandable that the AIDS vaccine be touted with such determined optimism. In September, 1998 Washington Post reported on the "remarkable success" of the new prevention strategies. Across the world, the paper said, HIV infection rates were decreasing. In places like the Dominican Republic, Brazil, and Uganda, and the Ivory Coast, and in Tanzania,, where a three year trial aimed at decreasing sexually transmitted diseases had "reduced HIV transmission by 40 percent". An administrator from the AIDS Control and Prevention (AIDSCAP), Brian Atwood, told the paper: "this agency has made a global contribution....over the years, we've learned so much about this..."

Learning about the risk of AIDS doesn't necessarily change sexual practices or result in long term success. The AIDSCAP program ran through the 1990's and despite the successes, suffered many obstacles. As with many of these programs, success can easily be derailed by staff turnover, sociological shifts such as stigma around disease or misunderstanding of disease etiology, uneven programming, funding shortages, interruptions, and politics.

According to the report, today in Tanzania infection rates are lower than places like South Africa, averaging at about 8%, but overall life expectancy in the country has decreased by 8 years due to AIDS. While HIV infection in urban areas declined by 16.65% from 2000 to 2005, in rural areas infection rates have markedly increased.

Other critical economic development measures have also regressed in Tanzania, for instance literacy rates dropped from 80% in 1980, to 60% today. In one survey of adults, 52% of women and 62.5% of men believed that a teacher who has "the AIDS virus but is not sick should be allowed to continue teaching."

Rewarding Behavior

Now, an experimental trial in Tanzania will attempt to attack this complex knot of problems underlying the HIV/AIDS epidemic with a market solution. The Financial Times wrote last weekend about a project in Tanzania that would pay people who practiced safe sex. The trial participants would take regular tests for sexually transmitted diseases like gonorrhea, and be paid about $45 if they remained disease free. The control arm of the trial would not be paid. All would be treated for any infections. Sexually transmitted diseases increase the risk of becoming HIV infected and Tanzania has long focused on this connection.

The project is sponsored by the World Bank, William and Flora Hewlett Foundation, the Population Reference Bureau and the Spanish Impact Evaluation Fund (affiliated with the World Bank). The Financial Times quoted Carol Medlin, a researcher on the project from the University of California, San Francisco, who said: "We hope this 'reverse prostitution' will make people think hard about the long-term consequences of their short-term behaviour."

The move is controversial -- can paying people for intrinsic choices motivate them? Can the complex set of problems underlying AIDS epidemics, involving everything from public health infrastructure, to politics, social norms, economics, and leadership, be resolved by motivating personal choices with money? In an accompanying editorial ("Cash for safe sex; Bribing Africans to be careful is bizarre - and worth a try"), the Financial Times suggested that the scope of the problem warrants such an attempt: "In the face of an appalling Aids epidemic, we should overcome our unease." Should we?

When Merck's AIDS vaccine candidate failed in clinical trials, the National Institute of Allergy and Infectious Diseases (NIAID), in the National Institutes of Health (NIH) called a summit. The drug candidate did not reduce HIV infections, in fact the adenovirus based vaccine seemed to increase the risk of infections.

The meeting of scientists on March 25th in Washington focussed on the future of HIV/AIDS research in light of the fallout of Merck vaccine trials. Scientists including Anthony Fauci, who heads the NIAID, agree that funding needs to be redirected towards a broader research agenda and ideas beyond drug development and vaccines. Science last week noted that the decision about whether to proceed with the large NIH clinical trial planned for its HIV vaccine is still pending. ("Review of Vaccine Failure Prompts a Return to Basics" DOI: 10.1126/science.320.5872.30)

Nature also reported on the summit last week, pointing out that these clinical AIDS trials went forward not necessarily based on the strength of the science -- one of the vaccine candidates had a unimpressive track record -- but because programs needed to "show the public that progress is being made, thereby justifying the millions of dollars from philanthropists and taxpayers". ("Broken Promises" doi:10.1038/452503a).

The Nature editorial offers analysis of this HIV-AIDS vaccine experience, noting that ambitious commitments made in a flush funding environment in the early part of this decade short-changed basic research. These choices to heavily fund drug development are regarded less forgivingly in light of the trial failures and the budget shortfalls of recent years, according to the journal. Nature warns other fields, for instance stem-cell research, autism, and Parkinson's disease, are repeating these same mistakes.

The business approach comes with a high stakes mentality and ample, vigorous marketing that can ratchet up expectations both within the organization, the field and the public arena. The business-oriented nature of many philanthropic organizations influences the focus on development and can distort public expectations. But investors can and do influence the direction of an entire field. When a field becomes dominated by a few foundations it can gather tremendous productive momentum, but it can also stampede so hard down a particular path with such strong momentum in a particular direction. If that direction proves to be less fruitful than hoped research cannot turn around on a dime.

Each high-funded disease has its own idiosyncratic pitfalls, but behind the good works and fine intentions of charities, but the science research rarely responds to pressure, unlike many entrepreneurial ventures. When scientists request research funding, the results don't always yield answers as quickly as businesses might hope -- research is the mythical man myth on steroids. Some people investing in biotech and international public health come from businesses very unlike public health with its vagaries of not only politics and human behavior, but biology.

In today's fast paced communications and computing climate, intense focus on "results" is inherent to our culture. Expectations carry over from the successful and extraordinarily speedy progress of the genome sequencing. Scientists and politicians built hopes during that time that drug development and an accelerated understanding of human disease would follow. It has, but did we expect more? TV drug advertising gives the impression that scientists are developing a pill for every insignificant hangnail, when many of these drugs aren't new, just the subjects of new marketing campaigns. Meanwhile tougher diseases and conditions remain elusive.

High profile funding can influence the research environment and lead to a very public dead end. In the larger picture, despite the wisdom that should be accruing from these experiences, politicians, technology leaders, and pundits sometimes wax-on about technology's potential to produce solutions not only for specific diseases but for extremely complicated social problems such as global warming and healthcare. But while science research may yield pharmaceuticals and oil extraction techniques but one cannot look to science or technology to solve the healthcare crisis in the United States. Science and technology contextualize these problems and are integral in our lives but despite heady declarations, they are not central to the solutions.

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Acronym Required has written previously about these subjects, AIDS and research directions, and vaccines. Here are a couple of our vaccine articles:

Vaccinations -- Why Worry?
Polio Vaccinations - The end of a scourge?
Group B Strep Vaccine Development
Vaccine Development For Infectious Diseases

Flipping a Nation

The press, scientists, and commentators were instinctively indignant yet unsurprised by the Environmental Protection Agency's (EPA) new ozone rules, which of course came out below science and public health recommendations. The agency changed the ozone levels from 84 parts per billion (ppb) to 75 ppb. Scientists agree that 60-70 ppb are necessary to decrease deaths and smog levels dangerous to children, the elderly, and those with asthma and respiratory disease.

Of course industry and the Bush administration weighed in on the matter, killing a secondary standard that EPA staff had recommended. The EPA's secondary standard would have allowed agency discretion to set temporary standards in the event of certain conditions like weather, for instance in to protect vegetation and wildlife from ozone exposure during growing seasons.

Considering the urgency of the situation, the EPA issued a flaccid ruling, but naturally held a full-court press conference to give agency heads the opportunity to beat their brave, intrepid, heroic chests. There, administrator Stephen Johnson spoke of standard as, "the most health-protective eight-hour ozone decision in the nation's history".

A New York Times editorial wrote:

"The big surprise was Mr. Johnson's proposal to rewrite the Clean Air Act to allow regulators to take costs into account when setting air quality standards. Since this would permanently devalue the role of science while strengthening the hand of industry, the proposal has no chance of success in a Democratic Congress."

What? The Bush administration whittles away government regulation? It marches "forward", privatizing various common assets like air, natural resources, forests and health that the administration acts like it inherited for the America public? Shocking. You the spin we hear about the redistribution of national resources as a principled, constitutionally sound, economically ideal (market driven) thing to do is -- well, spin? Surprise, surprise.

We can count the ways that our government ignores science in its decisions -- astute observers attend to this problem. The EPA itself attempts to gut the Clean Air Act at every opportunity, for instance after Hurricane Katrina (pdf!). But to the NYT editor's point, is Johnson's cost/benefit proposal outlandish? Not a chance of passing?

The EPA Saves "Living" Things: Documents

Johnson called the Clean Air Act a "living document" that needed to be "refurbished", "overhaul[ed] and enhance[ed]", "modernize[d] and upgrade[d]". There's really nothing to complain about on the face to this statement. Johnson announced his four "principles" for a Clean Air Act, including, to"allow decision-makers to consider benefits, costs, risk tradeoffs, and feasibility in making decisions about how to clean the air." The Clean Air Act was not "a relic to be displayed in the Smithsonian", he said.

The Times editor pointed out that Johnson's proposal would "cut to the very heart of the Clean Air Act", which was written to protect science from special interests by mandating rule-making based on health, not economic costs.

As we have witnessed, when the first hint of pollution regulation arises, any energy company worth its salt begins wailing about "technology not being available", about the exorbitant cost of the proposal, and about all the risks of complying when there is such scientific "uncertainty". Companies did just this when they held the nation in a decades long trance while they chanted about global warming uncertainty. Recognizing hints of recent history in his statement, and knowing how Johnson's incredulous suggestion could easily put estimates about cost and feasibility squarely in industry's park to the detriment of clean anything, we should become alarmed, perhaps leap into action and phone all our legislators.

However the NYT editor's tone sought to sooth us by calling Johnson's pronouncement a "revelatory moment", one that signaled the administration's "cry of frustration at being largely unsuccessful in undoing three decades of environmental law". Like the wolf frustrated in mid-hunt? One last guttural, spine chilling howl before giving up its prey -- and the fawn darts into a thicket of brambles just in the nick of time, a small defiant flick of its white tail?

Can we argue so optimistically, as the NYT editor did, that the Bush administration attempts have been "largely unsuccessful"? Knowing that standards should be set according to science can we be assured that, "the proposal has no chance of success in a Democratic Congress"? We love this view, can we share the optimism?

Ozone Decisions, Sunset Regulations and the Doyenne of Death

In Johnson's ozone ruling he said he followed the letter of the law and ignored "costs, net benefits and implementation challenges of more stringent standards", as required by the Act. Despite his words, scientists say that his new 75ppb standard was in deference to industry. Rogene Henderson, who chairs the Clean Air Science Advisory Committee, told Platts Energy: "I think [Johnson] is responding to the pressure of the industrial groups about the cost".

The idea that agencies need to consider the costs of clean water and air rulings on "small business" seems intuitive. But it can be manipulated to leave small businesses susceptible to lobby manipulation by groups like the National Coalition of Petroleum Retailers, who may officially represent "small business", but whose aims may appeal most strongly to huge business. In another example, look at San Francisco's attempt to limit bisphenol A, and the immediate lawsuit which of course included BPA manufacturers, but also listed as parties to the suit local toy stores.

Various White House meeting records also indicate influence on the EPA from the Office of Management and Budget (OMB), and its Office of Information and Regulatory Affairs (OIRA). A series of memos between Susan Dudley, the OIRA administrator, and the EPA, detail the Administration's influence in crafting the rule (available online www.regulations.gov). Over a couple of exchanges, the EPA refused to back down on the secondary standard. Then administrator Dudley issued a 'President-says-so' order March 12th: "The President has concluded that, consistent with Administration policy, added protection [Orwellian doublespeak?] should be afforded...by strengthening [more OD?] the secondary ozone standard and setting the secondary standard identical to the new primary standard..." Thus, the EPA was over-ruled.

Before Susan Dudley was chosen by Bush to head the OIRA, she distinguished herself by attacking what she saw as over-regulation, and she decried the diminished role of the OIRA and OMB in overseeing the regulations that agencies enacted. In the 1990's she roundly criticized the effect of a Clinton executive order, which shifted regulation out from under executive control to science agencies like the EPA. Dudley said the OIRA and OMB under Clinton had been made impotent and she urgently advocated for cost benefit analysis, especially for ozone and particulate matter rules. She chafed at how OIRA had lost its standing as the "watchdog for social welfare". (Regulation, Fall, 1997) As Reagan and H.W. Bush did before him, the current Bush administration has now spent the last 8 years pulling authority back into the executive branch. Dudley's interests are clearly aligned the administration's.

When Bush considered Susan Dudley to run OIRA, according the the Washington Post in 2006, "'Frank O'Donnell of Clean Air Watch called Dudley 'a true anti-regulatory zealot' who 'makes John Graham (previous OIRA head and Mercatus executive) look like Ralph Nader.'" In 2006 Public Citizen and OMB Watch published a report about Susan Dudley on the eve of her appointment to the OIRA, titled "The Cost Is Too High: How Susan Dudley Threatens Public Protections". The two groups argued against Dudley's appointment to the OIRA -- because her approach to regulation, they argue, was laden with "extreme-antiregulatory ideology". Public Citizen and OMB Watch went on to detail her background at the neoliberal Mercatus Center and her dedication to "embedding cost considerations in all laws that authorize agencies to protect the public, including...'safety first' laws" (like Clean Air Act).¹

Of course cost/benefit calculations involve valuing health, the environment, and quality of life. When considering the cost/benefits of smog then, here's a question: what's an acceptable threshold for the number kids who are forced to stay inside on high ozone days to prevent asthma attacks? Thousands? Millions? Particular cost-of-death calculations are often seemingly arbitrary, and long-term injury or morbidity that may or may not truncate a life are treated in an even more speculative way by CBA. Moreover, the end, what does this say about how the US values its citizens, its children?

At the other end of the age spectrum, according to the OMBWatch/Public Citizen report "Dudley has supported a senior death discount that counts the lives of seniors for less than the lives of the young". While this may be standard actuarial practice, pollution is more dangerous to the elderly, which make her calculations seem savage. For the prospects of regulations protecting our welfare the report pulls no punches in painting Dudley as the doyenne of death.

What Happens in "The Catbird Seat"

The report's authors also point out that not all "costs" have the same moral and ethical value. With the government's "regulatory budgeting", they say, "industry can knowingly expose the public to grave harms, enjoy the financial benefits of failing to take the steps necessary to protect the public, and then use compliance costs -- the costs of finally doing the right thing -- as a shield against being forced to comply with new protective standards."

Then there is Dudley's advocacy for sunset regulation, which 'imposes automatic extinction to regulatory policies then puts agencies in the position of having to justify regulations'. As we can see from global warming, environmental damage accrues with indecision. By the time a piece of the Antarctic the size of seven Manhattan's drops off, well, too little has been done too late. Decades go by with corporations lobbying for quarter to quarter profits, as the ice melts.

Finally, as Public Citizen notes: "Dudley would impose "regulatory budgets": fictional budgets of industry compliance costs, with a cap. Once an agency like the EPA hits its cap, it would be forced to stop promulgating any new protective standards, no matter how great the need."

As part of its regulatory oversight OIRA invites industry to suggest changes to federal rules. The Washington Post reported that shortly into President Bush's first term, when the OMB asked for public input on which regulations should be revised or killed, Mercatus submitted 44 of the 71 proposals that the OMB received. OMB approved 15 of them according to the National Journal.

In 2002, this number increased significantly. 267 regulations were targeted, 80 from business associated organizations and a couple dozen from Mercatus. As a result, in 2001 and 2002 the Clean Air Act and the Clean Water Act were changed by proposals that benefited industry sponsors like BP Amoco, ExxonMobil and Koch Industries and other Mercatus donors.² The Public Citizen/OMB Watch analysis predicted that when Dudley headed the OMB she "will sit in the catbird seat, overseeing the entire executive regulatory process...able to slow, stall, weaken regulatory proposals" to the detriment of public health and the environment.

Ozone Rulings and Regulatory Agencies

Bush worked around the nervousness surrounding Dudley's nomination by appointing her during Congress's recess. Dudley then immediately began to reclaim more ground for the OIRA. Specific to the smog ruling we opened with, Dudley had long advocated against smog regulations on behalf of industry. In 1997 testimony before the Senate Committee on Environmental and Public Works on the Subcommittee on Clean Air, Wetlands, Private Property and Nuclear Safety she argued incorrectly as the Vice President of "Economists Incorporated" that smog was beneficial because it protected individuals from ultraviolet radiation. In the same presentation she asserted preposterously that since research showed that asthma rates were associated with poverty, a smog ruling would have the "perverse effect" of costing communities money, which would in turn increase poverty and asthma. While she now works for government and on behalf of citizens instead of industry, she employs the same line of thinking.

The OMB for its part has the EPA in its sights for what it deems as engaging in misguided rule-making based on unreasonable scientific uncertainty and high costs. In the 2007 annual report to Congress The Costs and Benefits of Federal Regulations, OMB criticized the EPA for its determinations of the health effects of particulate matter: "the degree of uncertainty in benefit estimates for clean air rules is large. In addition, the wide range of benefits estimates for particle control does not capture the full extent of scientific uncertainty."

The authors single out six EPA rules on drinking water which they say cost state, local, and tribal governments or the private sector "over the threshold" of one hundred million dollars annually. The Clinton/Bush II Executive Order 12866, and Bush's two recent amendments, strengthened the OMB/OIRA's authority over the agencies, including putting executive appointed regulatory policy positions into each (decreasingly) independent agency.

Of course this OMB analysis doesn't expound on the enumerable benefits of clean drinking water free of cleaning agents, disinfectants or arsenic. And why one hundred million dollars? Some Senator's houses cost nearly that much. And this is a drop in the bucket compared to the Iraq war, which cost $341.4 million per day and has some mighty uncertain benefits.

The 2007 OMB costs and benefits report grounds its analysis in the philosophy that economically well-off countries have strong property rights and minimal regulation. The draft document veers often to pure right-wing citing the Heritage Foundation for information and absurdly saying that Communism was the result of excessive regulation gone awry.

No More Neighborhood Wimp

In an issue of Regulation in 1997 Dudley wrote before she was administrator about a previous OIRA administrator who had bragged that OIRA was the "biggest kid on the block", so other agencies had to respond to its agenda. She complained that the OIRA under Clinton was the neighborhood wimp. So although Dudley's perch at OIRA may be short-term, she had been preparing her tenure for decades and when nominated by Bush strode in to the post with a clear agenda.³

Johnson's proposal to rewrite the Clean Air Act is not out of left field, rather something urged for decades by industry, various government agencies, congressman and lobby groups. Furthermore, it's no more surprising then his smog ruling, if more appalling, since the changes he speaks of have been in the works for years and in fact progress towards the goals he articulated is well underway.

Health and the Environment: The Public's Standing

You'd think Johnson wouldn't even mention to Congress rewriting the Clean Air Act, given the spotlight on the EPA's recent record on the environment and the vocal admonition of members like Senator Boxer (D-CA). But Congress, though recently vocal against the EPA's refusal to move on environmental laws, has at times acquiesced eagerly to business deregulation and cost benefit guided rulemaking. Thus the current ease and confidence of Dudley in thwarting the goals of the EPA. Congress of course touts progress on all fronts, business, environment, and health, but business generally comes out the biggest winner.

Our intent is not to focus entirely on Susan Dudley, anymore than it is to focus on Stephen Johnson, or George W. Bush. They're all accomplices to a larger agenda which seems outmoded and outdated, that needs to be "overhauled" and "modernized". We are not in competition with Soviet ideology, capitalism is not merely ascendant, it's dominant -- so arguments in last year's OMB report to Congress about regulations on Clean Air and Water being nigh to Communism are absurd.

We live in a time when kids can't play outdoors because of smog, when business pollutes with abandon then screams about a rule that mildly asks, please don't pour oil into streams. We live in a time when the UN warns monthly about climate change and rising seas. This is the state of our nation today. This administration's decades old way of thinking deserves only to be encased in Plexiglas in a museum.

We live in a time when business calls the shots in Congress, in the White House and in the Judiciary, and we should all wake up to that truth. Yet voters still respond to "red phone" imagery with a knowing nod of utter naivete. There is no threat bigger than ourselves -- we are the traitorous monsters in our midst.

When the phone rings -- red, blue, yellow or green -- in the White House, in your Congressperson's office, or at the court house, it's not some nameless international threat, but an American industry whose TV advertisements you hum to and whose brand you endorse, and the person on the other end is calling to murmur in the lawmaker's ear about less regulation. One hand of the caller is slipping dollars into the decision-maker's pockets while the other waves fanatically to citizens about the economic doom of Clean Air and Clean Water, about the unemployment that will follow, and balance sheets that will run red. That's what happens when the red phone rings in the White House in 2008. Let's get real.

So what will elected representatives do for Clean Air? What they always do? Should the world have faith that Congress will protect Clean Air and Water? Sure, as long as somehow business benefits. But citizens have a choice, and always a voice, so we'll veer positive here. The NYT editor's right. The US evolves. Congress will see Johnson's clumsy marionette arms and legs being yanked by OIRA, his mouth voicing the agreed upon words from the decades old script. And your Congressman will answer the phone when citizens call, skip the form letter reply, and renounce Johnson's quest to rewrite Clean Air considering such things as costs, feasibility, and trade-offs.

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¹The report details how during seven years in the 1990's, Koch Industries (a petrochemical company) was found by the EPA to have spilled 3 million gallons of oil (300 unstopped leaks) into waterways in 6 states, and was fined $30 million dollars as a civil penalty (Koch founded Mercatus and is its largest contributor).

² Incidentally, Mercatus donors included Merrill Lynch, JP Morgan Chase, NYSE, Fanny Mae, and Freddie Mac. A quarter of the proposals the Mercatus submitted to OIRA in 2001 and 2002 were for financial services deregulation.

³Executive orders and congressional laws paved the way, for instance in the 1990's, rules such as the Unfunded Mandates Reform Act (1995), the Government Performance and Results Act (1993), and the Small Business Regulatory Enforcement Fairness Act (SBREFA) (1996), all addressed regulatory and reporting costs without expanding definitions of benefits. SBREFA, for example, spares businesses from what could be burdensome regulatory costs. Bush's latest rules significantly strengthen the clout of the agency.

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Acronym Required wrote previously about the EPA, the environment, and public policy.

Newsweek Now Decides Climate Change is Real

The title of Newsweek's current article, "The Global Warming Hoax", makes me wonder if Newsweek is still trying to appease all audiences, despite overwhelming evidence of climate change. The provocative title and cover photo with a giant burning sun gives the impression of a magazine intent on feeding the fire of debate. Inside, Sharon Begley coolly focuses on the deception of climate change by its deniers, who she says are running amok:

"....outside Hollywood, Manhattan and other habitats of the chattering classes, the denial machine is running at full throttle -- and continuing to shape both government policy and public opinion."

In the 4000+ word article, Begley profiles a cabal of naysayers', who say that global warming is false, unproven or unimportant. The article features the usual suspects, ExxonMobil, the Competitive Enterprise Institute, James Inhofe, Fred Singer, and Richard S. Lindzen. Its well worth reading if you haven't heard the denier's tall tales or want to read them again. Perhaps you went out and bought a Hummer after reading Richard S. Lindzen's 1000 word opinion featured just last April in Newsweek, fatefully titled: "Learning to Live With Global Warming, Why So Gloomy?":

"There is no compelling evidence that the warming trend we've seen will amount to anything close to catastrophe. What most commentators -- and many scientists -- seem to miss is that the only thing we can say with certainly about climate is that it changes...Many of the most alarming studies rely on long-range predictions using inherently untrustworthy climate models, similar to those that cannot accurately forecast the weather a week from now..."

Earlier this year, to be fair, Newsweek published an article from "the other side", about the the Union of Concerned Scientist's report on ExxonMobil's lobbying campaign.

The 50% Solution

It's not clear whether Newsweek's "balanced" coverage is in deference to its readers or its advertisers or both. This newest article comes at a time when ExxonMobil itself acknowledges climate change. "With its change of heart, ExxonMobil is more likely to win a place at the negotiating table as Congress debates climate legislation"

To Begley's point, the deniers still thrive in their slowly closing circle of lies. In fact they have now have been invited to the negotiating table. Those media outlets which broadcast the deniers articles also thrive. The Financial Times featured an editorial last week titled, "The Steamrollers of Climate Science", by Clive Crook, arguing that the IPCC and its reports were tainted by "pervasive bias"..

He acknowledged that it was written by numerous scientists, but wrote as if the IPCC was actually just a few scientists, four maybe -- Ian, Paul, Chuck and Cliff (IPCC). He recommended that "if governments are to get the best advice, they need information and analysis from an open and disinterested source". Who did Clive Crook have in mind? He quoted the opinions of David Henderson, affiliated with the Marshall Institute, Fraser Institute, and Competitive Enterprise Institute (CEI) (all funded by ExxonMobil).

Today, the Financial Times published two letters to the editor, one in complete agreement with, one disagreeing with his editorial. The rote, 50-50 solution that heedlessly denies the evidence.

Oil in The Melting (Shhhh!) Arctic

The climate change deniers ought to be experiencing cognitive dissonance that would compete with the "wind-induced" mechanical resonance that brought down the Tacoma-Narrows bridge in 1940.

While the denier editorial business thrives, last week Russia planted a flag in the Arctic, staking out future Gazprom profits, accessible with the melting waterway and the capital of foreign oil companies. The Financial Times itself reported on the opportunities in the Arctic and on various companies and countries chances of competing for oil in the article: "Arctic Ice":

"in a dreadful circularity, global warming, helped along by the burning of fossil fuels, is causing the Arctic's ice sheet to recede -- making any oil and gas there easier to access.

Spiegel, the German newspaper, wrote, "How much truth is there to the dire warnings of melting polar ice caps"?, asks the German newspaper Spiegel, in an article on the French Oil Company Total, a sponsoring explorer to the artic. The French company's stated purpose is to "measure the arctic melt" (and perhaps to send back pristine images for public relations efforts). Total is also working with Gazprom on Russian gas reserves in the arctic. Canada, Denmark, Norway, Russia and the United States currently claim parts of the North Pole.

The Heritage Foundation noted that "a quarter of the world's oil", may be under the caps, and "if the ice caps melt and shrink", the newly available resources will fuel foreign "tension".

Is global warming real? No it's not, say deniers, but then they add that whoever gets to the Arctic and its oil as the ice melts wins. If you're dizzy from snapping your head around to follow first the one side of their argument, than the other, simply follow the money for the truth.

Or do we know the truth and just want to drive around in our SUV's a while longer?

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Acronym Required previously posted about climate change with:
"Cars, Buying Cognitive Dissonance"
"Green Spirit"
Communicating Climate Change
"Sea Change or Littoral Disaster"

Last year, as avian bird flu H5N1 skipped around the world decimating bird populations and fatally infecting clusters of humans, governments near and far felt increasingly threatened by the possibility of a influenza pandemic. Tension and mistrust increased among countries at a time when full cooperation among them was essential to public health.

Countries promised $1.9 billion to a United Nations avian flu program but had yet to fulfill their pledges. The World Health Organization (WHO) established a repository for virus information from member countries at the Influenza Sequence Database (ISD) at Los Alamos National Laboratory in New Mexico in 2004, but the agency had a spotty history trying to deal effectively with infectious disease and was accused of beholden to the "gang of fifteen" labs given access to the data. The World Organization for Animal Health (OIE) and the United Nations' Food and Agriculture Organization (FAO) also committed to sharing data, but like the WHO, answered to their member states and could do little to compel countries to share resources. Private labs, the CDC, and individual countries like Russia, and China, had all been withholding data and biological samples, sometimes because of poor international relations, concern about intellectual property rights, or concern about credit for their contributions.

In response to the fragmentation in the research community, scientists, politicians and public health officials fulminated, concerned that hording virus and sequence samples would hobble effective responses to outbreaks. In February of 2006, Italian influenza scientist Ilaria Capua called on fellow scientists to promptly deposit their sequence data into gene banks."'Most of us are paid to protect human and animal health,' she said, 'If publishing one more paper becomes more important, we have our priorities messed up.'" ( Science 3 March 2006: Vol. 311. no. 5765, p. 1224)

By August she and about 70 influenza research allies, along with international consultant Peter Bogner, announced the establishment of a new, more open and collaborative system. Capua, Bogner, David Lipman, Nancy Cox and the others submitted a letter to the journal Nature announcing the Global Initiative on Sharing Avian Influenza Data (GISAID), a more collaborative and egalitarian effort to collect and share data in the scientific community.

The project is now set up and expected to begin accepting sequence data. Last week Science wrote that the database will live at the Swiss Institute of Bioinformatics (SIB) in Geneva. According to the article, access to the database will be free to people who register and accept the terms of use. Those who submit data have 6 months to take submit patents and scientific publications before their data becomes publicly available.

Last summer, people welcomed the initial announcement of GISAID and had high hopes for the collaborative approach. Yet some scientists are reserving their opinions until they know the exact terms of the agreement, still undisclosed. Others are openly skeptical of Bogner's motives, and wonder out loud why a media privatization mogel who is better known in skiing and sailing circles would pursue such a venture. For his part, he says he understands the issues scientists have with data rights from working with musicians. According to collaborators he has infused energy and financial backing to the project, and according to Science, might help bring future corporate funding .

Will sharing data help the frayed international relations? Emily Fitri of the Jakarta Post wrote her perception of the country's untenable situation in an article this week. Its unclear how well this represents the government's position in the wake of its agreement with Baxter. In summary she thought Indonesia and poor countries should be incensed for being used as "petri-dishes". While Indonesia struggled with geographical and informational challenges to containing bird flu she said, wealthier countries take cultures to study and make vaccines without offering assurance that whatever resulting remedy will shared with the country for an affordable cost. Indonesia has a right to be angry she says:

"There is a local saying cacing pun marah ketika diinjak, literally translated as even a worm gets upset when stepped upon. This must seriously be pondered upon by those with greater power to review their initial righteous intentions of creating a better world."

Indonesia said earlier this week that it would share data as soon as it is promised affordable vaccines. Perhaps GISAID will help promote the cooperation that is needed but it seems like a daunting challenge. Whatever relations are in place before a pandemic will be further tested in a crisis. Russia is in the midst of trying to control recent H5N1 outbreaks among birds in 8 villages around Moscow. The Moscow Times reported on the situation this week:

"A sign reading "Quarantine" welcomed a steady stream of vehicles passing through the checkpoint. The vehicles slowed down to drive over disinfectant-soaked sawdust intended to clean their tires. The traffic policemen took turns standing out in the icy wind and stopping drivers, ordering some to open the trunks of their cars and show their documents in a temporary cabin nearby."

The country is trying to vaccinate all birds and control the outbreak. One could imagine this scenario anywhere in the world. Some Russians interviewed for the Moscow Times article said that the control methods were arbitrary and that drivers circumvented the blockades by driving through surrounding villages. Others said it was a lot of hoopla for nothing. One veterinary worker who the Moscow Times interviewed commented: "Two chickens die and all this blows up. It's ridiculous."

Scientists agree that international cooperation is necessary to prevent infection and develop vaccines, and in the case of contagious human infection, to contain the disease and distribute medicines. Hopefully GISAID's accomplishment in meeting its six on-line month goal will reinforce the hope it engendered last August and help promote cooperation that citizens of the world are dependent on -- granted, a tall order.

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We also wrote about Avian Flu in these articles: Avian Flu v. Everyday Plagues, "Hopes For Avian Flu Vaccine"; "Modeling Epidemics", and "Avian Flu in China- Increasing Resistance", "Avian Flu Updates", and Avian Flu Pandemic -- Officials Save The Date"

In late December, Northfield Laboratories announced the results of Phase III clinical trials of Polyheme, a hemoglobin based oxygen carrier (HBOC), that ended last summer. The Wall Street Journal reported the negative results in "'Preliminary' Findings Of PolyHeme Death Rate Suggest Approval Setback"(12/20/06). We learned that 712 trauma patients with trauma and significant blood loss enrolled in the study. 46 patients treated with Polyheme died, versus 35 control patients who died from standard treatment. 13.2% of the Polyheme patients died versus 9.6% of the patients of standard treatment. The standard for care is to give saline to the patient during transport only until donor blood is available at the hospital.

The response to the negative news was immediate. Quite a few people suddenly distanced themselves from Northfield Labs. West Virginia University hospitals, who enrolled in the Northfield study and is listed on the clinicaltrials.gov site, issued a press release saying that even though ambulances were carrying Polyheme,"The drug, PolyHeme, was never used on any patients in West Virginia, according to Dr. Lawrence Roberts, director of WVU's John Michael Moore Trauma Center". (italics ours) The doctor defended the choice to participate in the study while dismissing the product: ''The data looks like the patients that got Polyheme had worse outcomes. That implies this stuff is no good and you can't use it."

Investors, brokers and some financial reporters, who had once rabidly attacked reporters and sites that brought up patient safety concerns, started echoing "I told you so" headlines back and forth to each other. The stock sunk from $17 to $4. Northfield Labs' CEO, Steven Gould presented to an investor teleconference last month and the WSJ noted his eternal optimism, saying he was

"'encouraged' and 'optimistic' that the company's blood substitute soon will become the first approved by the U.S. Food and Drug Administration to revive hemorrhaging patients." [WSJBurton, Thomas "Blood Substitutes Face Long Odds History, Scientific Concern Hamstring Sector" February 13, 2007].

None of this bodes well for patients. The negative results potentially impacted past patients who probably did not receive optimal care for their situation. Doctors, emergency workers and the military as well as future patients would benefit from a new product that delivers oxygen, survives storage and transport, and doesn't require blood matching.

In this clinical trial Polyheme's success is judged according to a simple but slightly unusual criteria. The goal was to show that the product "superior" to, "not inferior" to, or "inferior" to the standard treatment. The future of the product depends on how many people survived the Polyheme group as opposed to the control group. Northfield is now striving to get the FDA to label the Polyheme "not inferior".

The CEO called the shaky results "preliminary". He said that some of the data had errors because of "protocol violators", that is patients who were enrolled who for one reason or another should have been excluded. When these patients' data was removed from the analysis he said, then the results of the study looked better and would fair more favorably in an FDA review. True enough, the protocol violators died more frequently. Of the 126-patient "protocol violator" group that Northfield seeks to exclude, according to an analysis on Thestreet.com, by Adam Feuerstein, there was a large difference in death rate of patients getting Polyheme (17/70 or 23%), versus the controls (7/56 or 12.5%). However, since the trial was originally structured for patients with significant blood loss and trauma. Feurestein points out:

Northfield designed an ambulance trauma trial for Polyheme because it wanted to see how the blood substitute performed in the real world, where all kinds of patients are bleeding to death from all sorts of accidents. After the fact, when the results aren't to its liking, the company can't go back and argue that Polyheme works, but only when conditions are perfect.

Actually, Northfield also chose this particular patient cohort because previous trials of Polyheme (similar to other HBOCs) failed when the products were applied in routine surgery and non-trauma situations. These trials ended badly for patients, so the companies turned their attention to critical care scenarios where donor blood wasn't an option. Since we're at war (perpetually, now), there's a huge potential military market for these products which coincides with the uptick in FDA interest. But will the FDA will allow Northfield to meet the trial's patient quota with "protocol violators", then in retrospect exclude those patients? Some financial analysts like Feuerstein are doubtful. The FDA's actions will also be followed with interest by those in drug development, and those concerned with patient safety and clinical trials.

Northgate's Phase III trial attracted initial controversy because it necessarily waived patient consent in order to study severely injured trauma patients. The trial involved giving a blood substitute in lieu of saline during transport, and for 12 hours after the injury once donor blood was available. Doctors and people involved with patient ethics questioned whether communities were being educated adequately about the trials. People also probed why participating doctors and medical centers seemed unknowing about previous failures with the blood substitutes. Fortunately for Northfield, all of this controversy only heated up three years into the trial. Northfield stopped enrolling patients just a few weeks after a story about patient consent aired on 20/20.

However the next trial for an HBOC will be conducted differently. The FDA recently denied the company Biopure, Northfield's neck and neck competitor for over 20 years, latitude to conduct a Phase III trial with its competing product Hemopure. Instead it will conduct a Phase II trial with fewer patients and the use of Hemopure will only be allowed until donor blood is available.

Despite years of work and promises, some people doubt the HBOC's viability, due to decades of failures in clinical trials. The WSJ quoted a former medical director of Biopure Corp. in Cambridge, Massachusetts, a company that makes one of Polyheme's competing products Hemopure, who said that the '"totality of the data' on this class of products is that 'so much harm has been shown, without benefit, that the field should be stopped.'"

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Acronym Required previously wrote about Polyheme and Hemopure in Polyheme© and The Newest Plastic Bracelet. We looked at the history of the products, focusing on on Northfield and Biopure, in Polyheme& Hemopure: Life Savers? Products to Die For?

South Africa's Wealth/Health Paradox

South Africa, where approximately 1 in 9 people are afflicted with AIDS, has a paradoxical economic development profile. It is considered an upper middle income country based on its healthy Gross Domestic Product (GDP). The World Bank ranked South Africa's GDP 27th of 177 countries in 2005, putting it in about the 85th percentile for GDP. The International Marketing Council of South Africa, with the slogan "South Africa, Alive With Possibility", describes the country as the "economic powerhouse of Africa".

Yet about 800 people a day die from AIDS in this country. Life expectancy in South Africa has decreased by four years and deaths from AIDS continue to decimate populations of young women under age 35 and men in their 30's and 40's, people who are in their prime and who -- from an economic perspective -- are in the most productive years of their life.

Now more bad news. An alarming study from Statistics South Africa's shows yet another dramatic increase in deaths from AIDS in South Africa. The report analyzed death rates from unnatural and natural causes and found that the death rate from communicable diseases of South African women aged 30-45 had increased by about three times, from 500 per 100,000, to 1500 per 100,000 between 1997 and 2004. Male deaths from communicable diseases had also increased and had even doubled in some areas. Some of this bad news was predicted. Since there is a lag between infection and full blown AIDS, it was assumed that the death rates would not decrease until 2008. However the figures are still stunning - as they were last year, and the year before...

The expectations of economists and politicians was that post-apartheid Africa would rebound and that the health of South Africans would improve. Indeed according to economic measures Africa is doing better and foreign investment has skyrocketed. But even compared to Russia, where life expectancy decreased as a result of political upheaval and economic downturn, the current patterns in South Africa indicate a dire state of affairs. For scientists and doctors, the increases in deaths are distressing since there are few signs that action is being taken to stem the epidemic.

South Africa AIDS Policies

With full knowledge of the toll of South Africa's AIDS policies, international public health officials, scientists and doctors are taking South Africa to task and rightly so. Historically, the government has denied that the HIV virus caused AIDS, and it has been slow to implement treatment programs for AIDS afflicted patients. Despite pleading from world leaders, South Africa's AIDS policy remains one of obfuscation and denial. Health minister Dr. Tshabalala-Msimang often insists that nutrition will beat AIDS, and regularly pushes garlic, beets and lemon, and African potatoes as effective cures. Since patient treatment via antiretrovirals now costs less that $130 dollars a year. South Africa's health policies are out of step with the modernity and prosperity that it claims.

The country was condemned at the AIDS conference in Montreal this year for displaying a basket of this produce in its booth, initially without antiretroviral drugs. Earlier this year the country banned two non-governmental organizations (NGO's) from a UN AIDS conference because they were particularly critical of Mbeki's policies.

In the most recent international public plea for policy change, a group of 81 doctors wrote a letter to President Mbeki asking the president to replace the ineffectual health minister, Dr Tshabalala-Msimang. In response to the recent letter, the health minister complained that the international community was undermining the country's efforts. She has long defended her nutrition advice as "the truth", and allegedly doesn't mind her moniker- Dr. Beetroot".

In response to the outcry against him, the president has assigned a new committee to oversee the AIDS program, according to an associated press article (South Africa Scales Back Health Minister's AIDS Role). But the health minister denies that she has been demoted, and in typical sidestepping form, a government spokesperson, Themba Maseko, said: we need to shift the focus from saying the problem is the Minister of Health".

Effective AIDS Policies

AIDS programs succeed in countries because of many deliberate actions by leaders. It is imperative that there is strong leadership to combat AIDS at the very, very top levels of a government. So in South Africa's case, if the problem is not with the minister of health then it is with the president.

People have said that effective AIDS policies will be pushed to the fore by governments who realize that deaths impede economic progress. It's hard to imagine that South Africa, where 1 in 9 people on average are affected by the deadly disease and only a small fraction receive drugs, has not come to terms with this economic reality. Any government which claims that beetroot is as effective as antiretrovirals is, as Stephen Lewis put it: "obtuse, dilatory and negligent."

Once it seemed intuitive that a higher GDP could be linked to greater general welfare of a country's citizens. Economists now recognize that GDP doesn't always correlate with overall broader measures of prosperity. South Africa is a telling example of this phenomenon. The United Nations' Human Development Index (HDI) rates quality of life factors such as education, the status of women, morbidity, and mortality. South Africa's comes in at 121sh out of 178 countries. This puts it in about the 33rd percentile of all countries, in the company of many countries who have far fewer resources. Therefore in terms of HDI, as opposed to GDP, South Africa's is in the same band of countries that its pro-business groups lord over with their "economic powerhouse" status.

In this "post-apartheid" era, we would not expect this chasm between the HDI (where it lies in the 33rd percentile) and GDP (where it is the 85th percentile). We would not expect the travesty of preventable AIDS deaths. We only wish that such a sorry state of affairs would convince those at the top levels of the government that only an active AIDS program will assure that South Africa truly is, as its marketing campaign says: "alive with possibility".

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Acronym Required previously wrote about AIDS in Not in Paradise Anymore - AIDS in Africa - Reason for Optimism?" - in response to a David Brooks column and optimistic prognosis for the AIDS epidemic in South Africa. We also wrote about AIDS in Zimbawe, in Burma, as well as in other articles.

PLoS Medicine published an article in their Policy Forum this month, provocatively titled "Do We Need to Put Society First? The Potential for Tragedy in Antimicrobial Resistance" by KR Foster and H Grundmann. The article positions global antibiotic resistance as a proverbial "tragedy of the commons". The authors suggest that global accessibility of antimicrobials results in widespread antibiotic resistance and that although various parties try to curb the overuse of antibiotics by patients, "current policies may only partly solve the problem". Indeed, these efforts:

"do not address the conundrum at the heart of antimicrobial resistance: the solution may ultimately require us to put society before the individual. That is, halting the rise of resistance may only be achievable if some patients go untreated. We defend this uncomfortable conclusion using the logic of the well-known social dilemma "the tragedy of the commons."

This conclusion comes in the first paragraph. It's only dwarfed by the photo juxtaposed to the right of an oozing sore on the dark knee of a person inflicted with methicillin resistant Staphylococcus aureus (MRSA). As if an afterthought, the next sentence reads: "More data on the societal costs of resistance are required to evaluate the potential for a tragedy of antimicrobial resistance and the moral dilemma that it would present." One would have hoped that the "more data" part would come before the publishing part but perhaps tenuous commentary is the purpose of PLoS's "Policy Forum".

Though the topic sentence may affront, the theme of the article is more or less drug allocation and management, a vital concern to national and international drug and health programs. The proposal PLoS publishes may seem draconian but it is not foreign. Drugs are routinely made unavailable to various populations inadvertently or by design. Various drugs for infectious (and other) diseases are priced above what many patients can pay, and patents or trade regimes limit drugs' usefulness in order to maximize profit. The identification of subsets of people who will receive Tamiflu (whether it works of not), if and when bird flu becomes epidemic, and the hoarding of the drug is a obvious, recent example of drug rationing.

Drug production, allocation, distribution, and management are well discussed and argued in public health, policy, and economics circles. Antibiotic resistance is certainly on the rise and problematic. But is the "tragedy of the commons" a useful metaphor to analyze the problem?

Tragedy or Dismal Science?

Garret Hardin's 1968 essay, "The Tragedy of Commons" (available online at Science: Vol. 162. no. 3859, pp. 1243 - 1248 and here), describes how resources in the public domain tend to get overused and depleted. According to Hardin's views which stem from neoclassical economics, private ownership offers individual owners incentive to conserve a resource so as not to detract from its future value. "Common" resources by comparison, offer no such incentive. Therefore individuals tend to overuse "commons" because they only recognize the immediate value of what 'to their mind' seems like an endless resource, whereas any loss of value due to depletion is shared by many other individuals. There are greater individual rewards from taking then conserving.

Hardin's essay popularized a general phenomena described by Aristotle and others in simplified terms that are easy to grasp. It's most frequently applied to environmental problems: fisheries, water resources and pollution. It adequately describes these situations where at least at one time, individuals arguably had access to open resources. The parable's simplicity, popularity and malleability, make it easy to apply to other problems such as internet useage, university education or even - to dubious effect - asbestos litigation¹. "What we have here is a failure to cooperate", the asbestos article starts, citing a line from "Cool Hand Luke". The author contemplates how to restrain "asbestos plaintiffs,...[who are] arguably 'overgrazing' the accessible financial assets...",. The recompense is 'the commons' and the plaintiffs, 'the commoners'.

While the simple "commons" metaphor is useful, it can also be used for dubious intention to effectively blame individuals for complex societal problems, to erode individual rights, or to promote legislation that privatizes natural resources (even when it is clear that privatization does not necessarily solve common resource problems).

The PLoS authors chose to use the tragedy of the commons parable for the problem of antibiotic resistance based on an article about the Spanish national health care program: "Baquero and Campos recently argued that this dilemma mirrors what Hardin termed "the tragedy of the commons". It's clear from reading that article, however, that the Spanish authors write specifically about the public health program in Spain where doctors prescribe drugs to patients based on a national formulary. Baquero and Campos outline incentives that could be used for the pharmaceutical companies, doctors, and patients to curb excessive prescription use in the Spanish system.

The PLoS authors seem to discount the authors' solutions while liberally extending the metaphor in a vague way to global public health and antimicrobial resistance: "Protecting the antimicrobial commons, and hence the collective best interest, may require society sometimes to act against an individual patient's best interests.

The integration of antibiotic resistance and economics and public health via a framework borrowed from the 1960's isn't an easiest feat. Hardin himself warned in an article in Science (vol. 280: May 1, 1998):

"A final word about interdisciplinary work -- do not underestimate its difficulties. The more specialties we try to stitch together, the greater are our opportunities to make mistakes -- and the more numerous are our willing critics."

Though Hardin's original essay gained tremendous popularity, it also attracted criticism both for its methods and subject matter. The original essay addressed the overpopulation "problem". Hardin proposed that the "right to breed" could never be resolved or managed by government and the implications were disastrous. However, history doesn't support the catastrophe he predicted. Population growth was controlled via individual family planning. Virtually all developing countries' populations decreased with development that resulted in better public health, female education and increased wealth. But the "problem" still has it's staunch supporters in Malthusian circles, and Hardin recently said (1998) (Science:162): "The reality that underlies all the necessary curtailments is always the same -- population growth."

The failure of Hardin's predictions about population growth doesn't rule out use of the "commons" framework. It has been applied to great effect for conceptualizing environmental problems. But any model, no matter how popular, needs to be measured against the historical record and applied only with care to contemporary problems.

The authors claim: " Hardin's tragedy of the commons has proved to be a powerful analogy for understanding the problem of protecting the benefit we all receive from public goods". We argue that it is not the best analogy. As privatization has become the norm the concept of a "common" resource has become almost anachronistic. In the case of antibiotic resistance, it is neither powerful nor an applicable. There are more powerful models that provide better framework to analyze the problem.

Antibiotics are Private Goods

Different disciplines have different vocabularies for the same phenomena that are equally valid, but in the case of public goods economists can do better then the simple "commons" parable. Economists define "public" goods and distinguish them from from "private" goods. A public "good" benefits society and can counteract a "bad". The definition is refined by considering concepts of "excludability" and "rivalry". Lighthouses are the prototypical public good, with non-excludability and non-rivalry, as is national defense. No one can be excluded from using a lighthouse or public defense, and one person's use does not hamper another persons use. For a non-rivalrous good the marginal cost of consumption is zero -- it doesn't impose on society. Non-excludability of a resource, whether it's a light from a lighthouse, national defense, or a broadcast on public airways, is a requirement for a "public good", as is non-rivalry.

Economists further refine these ideas by distinguishing between pure and impure public goods, and pure and impure private goods. A lecture in a public auditorium is an impure public good. Although many people can listen, each person who listens limits the future number of other people who can listen in the space and is in this way rivalrous. Ocean fisheries are similiarly impure public goods, because they are rivalrous, although they people for centuries imagined the oceans a limitless resource.

Club goods such as health clubs and churches are excludable. All private goods, like clothing and haircuts are both excludeable and rivalrous. Such services and manufactured consumer products are considered pure private goods. Medicines are considered private goods, however private medicines can be distributed by public programs - but they're still private goods. Exceptions include world wide polio vaccination program, which could be considered a public good.

This framework is not perfect for determining whether a good is public or private. Close examination of such a complex problem is still difficult, but the framework makes it easier to discern whether a problem has more public features or private. Perhaps in a case of nationalized medicine like Spain, antibiotics are not purely private or public, however from a global perspective, antibiotics are private goods. Antibiotic resistance is a global problem.

Antibiotics are sometimes extremely scarce and sometimes abundant. In rural areas throughout the world people die of simple infections that could be cured by antibiotics. In other places like some cities in Asia, antibiotics are priced at steep discounts and used with utter abandon in combination with various other traditional and allopathic medicines. But in both cases private industry determines the scarcity or glut.

An article written by Steve Stecklow and the late Daniel Pearl, from the Wall Street Journal, August 16, 2001, available here at essential.org, illustrates the extent to which privatization determines the supply of antibiotics. The article describes the influence of various players in the pharmaceutical industry in India. It details some of the profit incentives of pharmacies (which often stand in for doctors in India). The pharmacists relationships with pharmaceutical companies become arguably more important than the individual patient. The incentives of the pharmacists influences drug sales and in turn effect the use and misuse of drugs:

"Mr. Patil [a pharmacist] also didn't disguise his motivation for recommending certain brands. 'The ultimate decision is based on what the margins are," he said. For fevers, he usually recommended a generic version of the antibiotic Ciprofloxacin; a recent incentive deal from an Indian manufacturer offered him a 250% profit margin and a chance to win a motorcycle..."

Pharmaceutical companies refuse to develop drugs for markets that can't afford to pay, and pharmaceutical companies supply drugs cheaply when there are surpluses. There are ethical quandries with this model as it stands, but pharmaceutical companies are acting as rational for-profit entities.

Antibiotic resistance could be considered a global public "bad". It hasn't always been seen this way. Doctors in the U.S. have been cognizant of antibiotic resistance for decades and have counseled American patients about conservative use of antibiotics. But they ignored or were ignorant to egregious misuse of antibiotics overseas and for the most part failed to conceive how this might effect the US. Antibiotics are not a global public good because they are privately developed, manufactured, sold and managed according to the profit motives of pharmaceutical companies. Pharmaceutical companies influence politicians to pass laws favoring the sale of drugs. Lawmaker participation is as instrumental to the problem as the prescribing habits of doctors.

This is not a simple dynamic between some individual herders and a pasture. Antibiotics are not a free resource open for public consumption, but a private product sold to consumers by pharmaceutical companies for profit. Yet surprisingly, the word "pharmaceutical" does not appear in the PLoS article. Neither do the words "industry", "company", or "business". The word "drugs appears twice:

• 1) "Most worryingly, some bacterial strains are resistant to multiple classes of drugs"
• 2) "...development of new drugs...comes at considerable economic cost."

It's telling that pharmaceutical companies remain unidentified in the article as playing a role. It's their market! It's also telling that "economic cost" makes the potential solution of research and development of new antibiotics unpalatable to the authors, even when they compare it to the "moral dilemma" of not treating patients.

The authors run through many possible solutions to the problems -- curbing prescriptions for viral infections, limiting antibiotic use in agriculture, government incentives for drug development. But they seem to toss these valid solutions aside because they don't fit the text of Hardin's original 1968 essay. Indeed the authors note at the beginning of their essay:

"What is most important for our discussion, however, is Hardin's key insight that a tragedy of the commons lacks a technical solution, which he defined as 'one that requires a change only in the techniques of the natural sciences, demanding little or nothing in the way of change in human values or ideas of morality.'"

Since their article hinges on Hardin's assertion that there is no "technical solution", it's as though they fixate on an answer that seems most likely to satisfy the 1968 article; the one that most emphatically challenges notions of "human values or ideas of morality." While they recognize all the misuses of antimicrobials in exhaustive lists in their essay and they also seem to recognize the international disparities in prescription guidelines, they toss these key issues aside in favor of their histrionic proposal that we: "face up to the reality of a tragedy of antimicrobial resistance".

It seems that to these authors, contemplating the loss of individual life is less horrifying than contemplating a change in the paradigm of how antimicrobials are distributed. Similarly, when the U.S. government contemplates climate change, it dismisses any proposal that might alter the economic incentives for the entrenched fossil fuel industries. Have privatization and sustaining business profits become subsumed as "human values", and taken precedence over other "human values" that we used to claim such as individual lives and liberty?

Brave Policy Decisions

It is difficult to take seriously proposals that omit important pieces of the problems they claim to consider and discard solutions that they claim to seek. An obvious snag in the logic of the PLoS author's solution, leaving selected patients untreated, becomes clear when imagining the difficulty of imposing such a broad solution successfully, given their assertion that none of the other smaller scale government solutions they considered seemed to suffice.

The biggest problem with applying the metaphor of the "tragedy of commons" to antimicrobial resistance is that it's too vague and amorphous an analogy. There are more cogent and analytical frameworks for contemplating the problem of antibiotic resistance, and by comparison, the "tragedy of the commons" only invites criticism. At best it seems like cultural shorthand that stands in lazily for a more clear-eyed, rigorous, nuanced delineation of a problem.

Such an analysis might question the contention that individuals are best served by international patent regimes that strong arm countries into limiting development of essential medicines -- a view that the authors endorse. This patent protection purportedly motivates pharmaceutical companies to develop new drugs. But if this were true, than why continue excusing companies from not developing drugs because of "economic cost"? If this "...careful use of patents", did indeed encourage drug development, than why would the profit reinvestment need to be further augmented by "government investment" -- especially when governments already provide the means for basic research upon which most drugs are developed?

We could also question how individuals could possibly be culpable for antibiotic resistance: "every herdsman knows that putting too many cows upon a pasture will eventually destroy it by overgrazing. Who "knows" more? The patient in India who walks into the pharmacy as in the WSJ article, hoping to cure their illness? Or the pharmaceutical company that sells them the drugs? Furthermore, does the right of a company to spare "economic cost", trump the right of an individual to spare his own life with medicine that he pays for either with money or taxes he pays to support national healthcare?

While the authors readily acknowledge many features of the antibiotic resistance dilemma, they do no service in forwarding the notion that individuals should bear the brunt of inefficient antibiotics distribution. For years pharmaceutical companies have propagated antibiotic resistance with greedy business practices like dumping pharmaceuticals into markets where their cheap price practically guarantees overuse. Whether the individual is an MRSA patient in a London hospital, an AIDS patient with an opportunistic infection in South Africa or India, or a child with strep throat in the U.S., the individuals with infectious diseases are not plundering the drug supply, nor are they responsible for the problem of antibiotic resistance.

The authors conclude that "difficult choices" are in store that may "require brave policy decisions". If governments enacted policies that sacrificed individual treatment via antibiotics would this really be "brave"? This seems routine, business as usual. However, what if governments chose instead to contemplate aspects of the current for-profit paradigm of pharmaceutical companies, the issue that the article published by PLoS; "Do We Need to Put Society First? The Potential for Tragedy in Antimicrobial Resistance", tries to ignore? Wouldn't that be "brave"?

¹ Francis McGovern; "The Tragedy of The Asbestos Commons", Dec. 2002; Virginia Law Review Vol 88, No. 8.

Temporary Optimism For Temporary Housing

Following the tsunami there was quite a lot of media coverage focused on the outpouring of support for rebuilding communities demolished by the sea. The waves killed hundreds of thousands of people across Southeast Asia. In Aceh, an estimated 120,000 houses needed to be rebuilt.

The tsunami has long lasting human tolls, not only in deaths, disease, ruined livelihoods, and material destruction. It also eats away at optimism. Following the tsunami proposals for temporary housing in Aceh poured out. But not Indonesia's rebuilding is bogged down in the harsh realities of bringing the project to reality.

At one time, it seemed like arrangements for temporary shelter would quickly emerge from the many proposals highlighted by the media....

• Harvard/MIT's "Sri Lankan house", touted as not only economical but "built with local materials and engineered to withstand a tsunami".
• Architecture for Humanities' structures, designed specifically for use in India and Sri Lanka.
• World Vision's project of 139 houses, lauded "as 'best practice' in post-tsunami rebuilding".
• Projects NPR noted were low-cost and framed with cheap, flexible, strong bamboo.
• Homes by architectural wunderkind Daniel Libeskind, who worked pro bono to rebuild a town in Sri Lanka.

There were a plethora of architecturally innovative ideas from universities and architects for sustainable projects and innovative solutions. But now building progress on temporary housing stalled because of a shortage of wood, according to a Financial Times. 67,000 people still living in tents and "only 800 of the planned 20,000", temporary homes are finished in Aceh. What happened?

Sourcing Lumber From Canada

Materials for rebuilding turned out to be the sticking point. Concrete used in many places isn't a sound seismic choice. Steel and tin were initially used for temporary shelters in the Andaman and Nicobar Islands, turn out oven-like structures which are uncomfortable for the climate. Solutions poured in but wood was the most practical building material. therefore reconstruction depends on lumber sourced from foreign countries. (Still, illegal logging in places like Gunung Leuser National Park by industrious entrepreneurs threatens to destroy local forests.)

Conservation International wrote that they successfully advocated for the use foreign wood . By May of 2005, donations had been offered from US, Australia, Belgium, Finland, Sweden, New Zealand, Germany, and Denmark. British Columbia wooed Indonesia with their ideas of wooden prefabricated homes, cut from Canadian forests, shipped to Aceh, then trucked to villages and assembled.

Getting timber from places like Canada however, ties progress to shifting environmental standards, the "inexperience of many aid agencies in sourcing large amounts of wood.", and promises like: "a UK-based timber broker was expected in coming weeks."

In addition to the challenges of sourcing timber from far flung places such as Canada and Sweden, organizations coordinating rebuilding efforts must also get clearance from the bureaucratic Indonesian government. So, along many NGO's have neat press-ready plans to show and tell, but scaling those plans and coordinating all the agencies to meet the epic challenge of the massive reconstruction effort of the tsunami isn't easy.

Little Cardboard House Models

The challenge of affordable, sturdy emergency housing has been solved over and over again by innovative teams of architects, at universities and via the dedication of non-profits and lots of generous support. But the problem remains historically unresolvable. An article in Slate last year described the issue:

"Architects in the past have proposed a variety of ingenious shelters, including prefabs, inflatables, geodesic dome kits, sprayed polyurethane igloos, and temporary housing made of cardboard tubes and plastic beer crates. As Davis [the author refers to Ian Davis, who wrote the book Shelter After Disaster (1978)], points out, not only are these often untested 'universal' solutions generally prohibitively expensive, their exotic forms are usually ill-suited to local conditions. That may be why such shelters, when they have been deployed, have frequently been rejected by users, and why historically the most common temporary shelter is the tent. Emergency housing sounds compelling, but it almost never works."

This wouldn't be a surprise to citizens of the areas hit. Six months after the crisis, many areas had already tired of the slow, spurious progress. In India the Habitat for Humanity proposed one model for a house for Tamil Nadu. Prompted for a reaction when shown "the little cardboard house model", a lady from Killai commented:

"People have been here before talking about houses; now they are gone. You are here now, but how do I know you will come again?"

Temporary housing is not the only rebuilding issue. Aid organizations overseeing the rebuilding of thousands of boats that were also destroyed in the tsunami report conflicts size and technology of the boats being built; many are smaller than the larger trawlers they are replacing, which may lead to over-fishing in shallow waters. The boats are also apparently made of unseasoned wood, because of the timber shortage, which is far less seaworthy the seasoned wood.

Though many of the problems are expected given the scope of the disaster, life remains on hold for thousands of Indonesians on Aceh still living in "rotting" tents while agents track down millions of cubic feet of lumber half a world away.

We arrived in Bankok, Thailand on the 26th of December at about 12:00AM last year and when we awoke in the morning people were standing around TVs trying to make sense of news about the tsunami. It was clear from the TV images that the waves were monstrous and destructive, but it was initially hard to fathom how many people were involved. Thais in Bankok desperately tried to reach their relatives in the South. As more footage of waves crashing through beach towns came through and people ominously failed to contact their families, the tension grew. We logged on to CNN and there the only news of the tsunami was a story about one American who was possibly lost on one of the islands¹. The family had mined some FBI connections to track their son and publicly pleaded to the president to mobilize efforts to help find him on the island of Phi Phi. They enlisted a senator in their search, who commented on her limited ability to help:

"What's really frustrating is this is the 21st century and you would think there would be some kind of communications . . . some kind of direct link from someone on the ground in [Phi Phi]"

Unbeknownst to the senator, the communication gap that frustrated her wasn't a 21st century technology glitch that inspires crankiness in all of us but the fundamental effect of an abrupt 20 metre vertical displacement of the ocean floor. The geology of the 9.15 earthquake and resulting tsunami in the Indian Ocean is difficult to imagine -- even if you were there in Thailand, India, or Sri Lanka. The further away you were from South East Asia the longer it took to realize what was going on, based on the steady stream of e-mails we got weeks after the initial earthquake. Some of it was the political process. President Bush was on vacation and took days to say anything.

Aside from distance and politics, the fact is that the communications infrastructure was literally wiped out, making communications logistics not so obviously impossible. Even watching natural disaster extravaganzas like "Deep Impact" or "The Day After Tommorrow", would hardly prepare one for the destruction. The fault slippage generated by the earthquake covered an area of 1300 by 100 kilometers. The energy released by the earthquake was estimated to be the equivalent of about 475 megatons of TNT -- 23,000 Nagasaki atomic bombs. The earth wobbled on its axis.

Waves generated from a large earthquake travel very quickly across the open ocean with speeds up to 500-1000 kph. They are short waves (one or two metres) on the ocean that then slow down when they approach land. There, the wave -- which is technically not so much of a wave, but rather a wall -- gains height. The resulting walls of water are extraordinarily powerful. Predicting their landfall is trickier then it may seem.

The Sumatra earthquake was initially measured as a 8.1-8.5 earthquake, then later revised upward to 9.15 using the moment magnitude scale rather than the seismogram amplitude (Ms) measurement. The difference between the size of the actual earthquake and the smaller initial measurement affected the tsunami predictions.

Cries for a tsunami warning system could be interpreted to indicate that this will solve the problem. It's true that before the tsunami there was a warning system implemented in the Pacific ocean but nothing in place for the Indian ocean where tsunamis were considered a rarer event. Warning systems are now being devised. The newest one is being designed by German researchers, who, relative to the Americans and Japanese, are newcomers to the field. The German system employs buoys that monitor surface conditions and relay this information along with sea bed information via satellite to a receiving station. Two of these buoys were installed in November. Tidal gauges will also eventually be engineered to monitor the data. These are part of the Global Sea Level Observing System (GLOSS) used in climate change studies. They are being upgraded to measure sea level information that will be useful to monitor tsunamis. There are also traditional communication systems based on seismic data that are now improved to forward warnings after earthquakes to countries vulnerable to tsunamis.

The improvements cannot come quickly enough. Der Spiegel reports that the stress of the Australian Plate beneath the continental shelf is higher then ever and the two recent earthquakes seem to have increased the tension since they only affected a small length of the border between the plates. But the 21st century communications system the senator laments may well be illusory.

We know that a warning system will never stop a hurricane or a tsunami. The warnings will help those who are capable and willing to heed them. Similiarly, during the rescue, technology will certainly improve the odds for many, though not all. But will it perform to the specs we expect? As with our all disaster, the response is as likely to depend on our neighbors as the technology -- on island or off; to whit, our neighbors judgement, instincts, and dare we say "emotional intelligence" will abet our survival or peril. These are the qualities in humans that sometimes seem disconcertingly unchanged since we all hunched over those first sticks trying to get sparks to fly. Sure there are enough heros, geniuses, and cats rescued from trees these days to buoy our spirits during the evening headline news. But in catastrophes, the weaknesses as well as the strengths of our fellow humans are evident, and as important as the "technological communications" systems. We will be as dependent on the chain of humans relaying the messages as we are on the physical limitations of technology -- even if the next tsunami leaves the infrastructure linked.

There were remarkable heroes in the tsunami last year. Some of the survivors stories are extraordinarily well told in the recent New York Times article "The Day the Sea Came", by Barry Bearak, which describes the turmoil and human toll of the event through the eyes of a few survivors. Many more stories we will never know, as those heroes perished with hundreds of thousands of others. If only technology could have saved them.

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¹The news must have gotten more in sync with the reality in time because CNN recently won the an award for best coverage for its stories on the tsunami.

Bats have a mixed reputation. Aside from their roles and fame in fact and fiction as vampires, they pollinate plants and have a voracious appetite for insects. Apparently little brown bats can eat 1,200 mosquitoes per hour. On the other hand humans fearfully associate bats with rabies virus, and occasionally with histoplasmosis, a respiratory infection transmitted via the fungus Histoplasma capsulatum - found in bat guano. But Bat Conservation International (BCI) battles their bad reputation, and points out that bats are only responsible for 1 death per year in the United States and rabies is found in only 6 of 45 species continental U.S. bat species, whereas dogs - "man's best friend" - are responsible for more fatal maulings of humans every year.

However bats are increasingly found to harbor fatal viruses. Bats are natural reservoirs for the Nipah and Hendra viruses. Bats have been linked to West Nile Virus. They have also recently been found to be the natural reservoir of the coronovirus that causes severe acute respiratory syndrome (SARS). Researchers found that bats were immune to symptoms of SARS and were the natural reservoir for the virus, whereas civets, the animal suspected of being the reservoir, whose populations were culled by about 10,000 in China in 2004, is only a carrier of the disease. The coronavirus was found in three species of horseshoe bats - a fruit bat.(Li et al, Science vol.310 pp. 676).

Bats have long been linked to human cases of Marburg and Ebola viruses, primarily because they're routinely found in places where humans contracted the viruses, a barn in one case, a field in another case... Since the 1970's, following almost every Ebola virus outbreak, scientists combed the surrounding areas for the source of the virus -- collected thousands of vertebrates and arthropods and tested them for the virus or antibodies to the virus. Most of these studies came to a dead-end -- no virus was found, no immune reaction detected in the specimens. Scientists also tried to infect cells and animals with the virus to no avail until earlier this year when they managed to infect a couple of bats. But the infection of the bats was not reproducible and the researchers did not have confidence in their data. (Pourrut et al.; Microbes and Infection, Vol. 7, pp 1005-1014)

They pursued that line of research though, and scientists reported last week that three species of fruit bats in Africa carried asymptomatic Ebola virus (Nature 438, 575-576). Researchers tested over a thousand small animals captured from around Ebola sites, assayed serum samples for antibodies to the virus, and spleen and liver samples for viral RNA and RT-PCR nucleotide sequences. Some bats were found to be Immunoglobin-G positive and others screened positive for nucleotide sequence analogy of Ebola viral RNA, however no bats were positive for both. Viral RNA could not be isolated. The authors discuss their results in their article. The fact that they found Ebola in the fruit bats helps solve a piece of the Ebola puzzle, but there are more unsolved questions. For instance, how do the bat's immune systems protect them from viruses and how do spillover events between species trigger the ever transient emergence of Ebola and other viruses?

Although we don't understand a lot about bat immunology we do know something about their community ecology. Bats often eat on the fly. They eat fruits and insects but extract the juice and sugars and leave insect carcasses and partially eaten fruits for animals and humans. As humans habitats increasingly overlap with bat habitats, chance interactions or disease spillover through other species like pigs or civets becomes more common. The link of the lethal viruses to bats is likely a harbinger of future infectious disease challenges.

The number of pathogens is arguably increasing with changing environmental, ecological and human factors, and many emerging viruses have lethal pathology including severe neurological symptoms. Over half of emerging infectious diseases come from animals (zoonotic), so understanding how the diseases are transmitted between species is critical to controlling them. It is increasingly important for understanding pathogens to probe anthropogenic affects on ecosystems and reconsider our relentless forays into nature and pension for development.

Ebola and other zoonotic pathogens have company among a growing number of emerging and re-emerging diseases. Bats are increasingly found to be the reservoir for viruses that are fatal to humans. While "zoonotic" is strictly a biological term indicating the source of a pathogen, to anthrocentric thinking the term has the rhetorical effect of indicting the reservoir animal. This does not bode well for bats. Animals suspected of harbouring disease are culled as the first line of defense for humans. But if humans encroach on an ecosystem, change it to suit their short-term needs, and at the same time disrupt it to the extent that new species take hold and previously established species are forced to adapt - or by chance become natural reservoirs to emerging pathogens like Ebola...isn't the virus the result of human activity? Isn't its zoonotic "source" a circumstance precipitated by the arrival of humans? Perhaps hard to say, but so far bats seem to conserve themselves through their immunity to the virus. Humans might be better served if thinking in conservation and environmental ecology was as deep as it is in vaccine development and animal control measures.

Only a few years ago, in 2002-2003, China dealt with outbreaks of Severe Acute Respiratory Syndrome (SARS) in a famously secretive manner that hampered international public health agencies as they tried to analyze and control the disease. Since then, China has made efforts to improve the swiftness and openness of its public health reporting. Yet outbreaks of the H5N1 avian flu strain occurred in China earlier this year and again the international public health community criticized China for not cooperating with international public health goals. They publicly suspected that China had wantonly authorized widespread use of the antiviral drug Amantine to innoculate chickens.

In the wake of SARS, China took pains to address its international public health image. The country invested millions of dollars to build an epidemic reporting system. The move to vaccinate its 14 billion domestic fowl against against H5N1 is somewhat controversial, nevertheless China is marching through the Herculean task. China itself is most self-congratulatory about these efforts, but it has also drawn recognition from public health organizations like the World Health Organization (WHO).

Despite progress, there are continual reports of information bottlenecks. There is persistent world-wide suspicion about the country's reported numbers because of China's historical lack of candor. Combined with increasing edginess on the part of health officials about an H5N1 pandemic, the atmosphere is ripe for rumors and panic. Last week Japanese virologist Masato Tashiro reportedly told a German newspaper that China had far more deaths from H5N1 than it led the world to believe. China defended its accounting vigorously and Tashiro has since denied his original accusation, insisting that he referred only to China's general issues with accurate reporting. At the heart of the unresolved questions, fears and suspicions, lie the real challenges to accurate reporting. Among these are geographic logistical challenges, disparate government agency agendas, and incorrect international perceptions of state power in China.

Real logistical barriers to collecting statistics are sometimes blithely ignored. New York Times wrote in, "Experts Doubt Bird Flu Tallies From China and Elsewhere", about discrepancies between Chinese officials' epidemic statistics, that seem far less then foreign expectations. It was an interesting article, but noted that "news on outbreaks has sometimes been slow to emerge from provinces and to the state media. Vietnam, in contrast, posts a daily 4 p.m. update on the Internet, detailing human and animal infections." It didn't weigh that China is about 9.5 million square miles, whereas Vietnam is 329,560 square miles, and that China's population is 1,306,313,812 people whereas Vietnam's is 85,535,576.

On top of very real logistical barriers to consistent reporting, observers see a striking lack of cooperation between government agencies. China Digital Times translated the October and November issues of Caijing Magazine recently, which reported that prior to 2003 veterinary epidemics were state secrets. China lifted this rule but there is uneven progress towards openness. The Public Health Ministry makes genuine efforts to appease foreign requests for information, however the Ministry or Agriculture is insistent that certain details of planning for an epidemic are "not public". Problematically, a subsidiary of the Ministry of Agriculture is reportedly the only organization that is authorized to research the avian flu virus. The lack of communication between agencies apparently figured in the obfuscation of pertinent information about the alarming number of human deaths in the outbreak of Streptoccocus suis in swine earlier this year according to Caijing. A WHO official investigating the S. suis epidemic shared this view -- that China's "human health side" was cooperative, whereas "veterinary" information was not forthcoming. (Science Vol. 309. pp 1308-9).

China's public health system is part of a maze of political and economic ambitions at the national and local levels. We often perceive China to be a centralized top-down authority, but the reality is that local politics and decentralized control often determine the outcomes of state policies. As economists and businessmen know, at different levels - provinces, districts, villages - officials have different approaches and capabilities for their duties. These individuals (as anywhere) are often motivated by personal ambitions that propel behavior that's not necessarily in national or international interests. Reporting is one certainly a critical aspect of public health; who's getting sick, where and how determine medical action. The AIDS epidemic is an example of devastation wrought when a disease gathers momentum because countries deny epidemics among their citizens. In China especially, infectious disease reporting depends both on the complicated and unpredictable social organization of individuals from the bottom up, and trust that key facts will survive the labyrinth of bureaucracy and political motivations.

Epidemics gain a foothold when public health is inadequate. China's health care was once centralized and rural health cooperatives and barefoot doctors provided insurance and care to people isolated in the country. This effective though sometimes idealized system was dismantled by the government in the 1980's. Health care was privatized, barefoot doctors abandoned their traditional practices to sell pills, and the cooperatives were disbanded. Medicine became expensive and decentralized, with resources concentrated in the cities and many individuals left without access to health care. Care facilities vary widely and different areas lack cohesive policies. Depending on where someone is located, if they are sick with flu, they may not be able to access a doctor who would recognize their symptoms.

China can try to rectify its public reporting system, but this on its own would be a superficial solution to problems within the current public health system. Nor does it address issues stemming from a political system habituated to secrecy, fiefdoms, and protecting local semblances of order. Its quite likely that the reports of an isolated case of a sick duck here or there covered up larger outbreaks of H5N1. While H5N1 was a "state secret" veterinary epidemic up to 2003, it had years to gain a foothold as a virus, and perhaps there are other diseases that are also threats. H5N1 is not the only infectious disease threat, in China or elsewhere.

The world's public health now relies in part, incongruously, on cohesive individual actions from the bottom up all over the globe. Today all eyes are on China. The world depends on a different type of China, but while the country seems to be moving towards transparency, change is slow. And its not only China, effective international public health care, which includes reporting, national and international cooperation, and sound politics (the position seems unfilled), all influence the outcomes of infectious diseases. Increasingly isolated country protocols affect global public health.

Josefina Coloma and Eva Harris write in "Open-Access Science: A Necessity for Global Public Health", that all aspects of science, including research, publishing and licensing need to be made more accessible to scientists in developing countries. They argue that many of medicine's most pressing challenges persist in developing countries, yet scientists and doctors in those countries are often excluded by the less-than-international research and development processes that they depend on to address their unique medical challenges. The authors note that in every area doctors and researchers in developing countries compete unfavorably with those who have access to the collegial science environment that favors success within an ethnocentric 'western' paradigm. To address this inequity they urge that:

"...the whole spectrum of scientific endeavor should be as open access as possible, from training in laboratory and epidemiological techniques, proposal writing, and manuscript-writing skills to open-access publishing and socially responsible intellectual property policies."

In the familiar book from 1997, A Demon Haunted World, Carl Sagan dismisses ghosts and monsters and fairies and demons. He bemoans the state of science literacy.

It's a common theme. In 1883, in an article in Science, "From Superstition to Humbug" (41: 637-639) an anonymous author wrote that the natives of India "exalt[ed]" English commanders "as more than human beings". In a tone that would resonate with many anthropologists of the day, the author comments on such "savage" inclinations:

"a benighted and superstitious populance, astonished by exhibitions of power...should, for a time, turn from its own hazy gods to new and visible wonder-workers"

Unfortunately, the article goes on to say, concepts of science are similiarly treated as some supernatural power, distorted and distended by so called civilized charlatans and naifs:

"It is curious to see how those, who a generation or two ago, would have been believers in witchcraft and all things 'supernatural' are now turning to be caught in the toils of scientific charlatanry..."

The newest topic that this 19th century author is concerned with is electricity:

"It is not with any intelligent reference to these exceedingly minute [physiological] currents...a man speaks...offers to rub a weak or disabled arm because he is 'strong and full of electricity, you know'. The fact is, we don't know, and we wish the man would explain..."

He fears the subject is corrupted by media and the public:

"It should be observed, however, that the kind of half-knowledge of this subject [physics] which is frequently obtained from newspapers and even from public lectures and popular scientific books, is the very pabulum of such errors and humbugs as we have described...It is the advance from pure superstition, in which men did not reason at all, to humbug, in which they reason from false or insufficient premises to wrong conclusions...Take, for instance, the modern master of that ancient black art of divination by rods..."

The author notes hopefully -- as we ever are -- more fuel for the notion of our flawed psychology, that physics education will improve and students will learn truth from fiction via better classroom teaching techniques:

"The tendency of the times, however, is toward the objective and experimental in teaching; and it is probable that the next few years will see considerable changes in the methods of general instruction in physics."

Over a century later, we are amazed at the constancy of human nature through distracting flashes of scientific progress -- whether the appearance of progress is a sleight of hand we don't know -- but witches, ghosts and appartitions and superstitions are alive, well, and always entertaining. CNN reports on witchcraft class deductions allowed by Dutch Law. According to the story on CNN a letter from Finance Minister Joop Wijn wrote of the decision, "Under the circustances, the cost of a course to become a witch qualifies as school fees."

The teacher of witchcraft Margarita Rongen's noted to one disbelieving lawmaker: "If he would come her and try the divination rod and see how important it is to find things..."

The Committee on Science, Engineering, and Public Policy (COSEPUP), comprised of members from the National Academy of Sciences, National Academy of Engineering, and the Institute of Medicine suggests some tactics to advance the lagging science prowess of the U.S. Their recommendations are published here in PDF or paperback form, titled "Rising Above The Gathering Storm: Energizing and Employing American for a Brighter Economic Future."

The National Academies press release for the study lists some of the actions they propose to stem what the committee views as decreased interest and competance in the U.S. for science and math. There are clear indicators of the nation's flagging abilities, they say:

• "For the cost of one chemist or one engineer in the United States, a company can hire about five chemists in China or 11 engineers in India".
• "Last year chemical companies shuttered 70 facilities in the United States and have tagged 40 more for closure. Of 120 chemical plants being built around the world with price tags of $1 billion or more, one is in the United States and 50 are in China".
• "U.S. 12th-graders recently performed below the international average for 21 countries on a test of general knowledge in mathematics and science".
• "In 1999 only 41 percent of U.S. eighth-graders had a math teacher who had majored in mathematics at the undergraduate or graduate level or studied the subject for teacher certification -- a figure that was considerably lower than the international average of 71 percent".
• "Last year more than 600,000 engineers graduated from institutions of higher education in China. In India, the figure was 350,000. In America, it was about 70,000".
• "In 2001 U.S. industry spent more on tort litigation than on research and development".

The press release summarizes the recommendations of the report:

• "[T]he creation of a merit-based scholarship program to attract 10,000 exceptional students to math and science teaching careers each year. Four-year scholarships, worth up to $20,000 annually, should be designed to help some of the nation's top students obtain bachelor's degrees in physical or life sciences, engineering, or mathematics -- with concurrent certification as K-12 math and science teachers. After graduation, they would be required to work for at least five years in public schools..."
• "Policy-makers should increase the national investment in basic research by 10 percent each year over the next seven years."
• "Each year, policy-makers should provide 25,000 new, competitive four-year undergraduate scholarships and 5,000 new graduate fellowships to U.S. citizens enrolled in physical science, life science, engineering, and mathematics programs at U.S. colleges and universities."
• "Policy-makers should provide a one-year automatic visa extension that allows international students to remain in the United States to seek employment if they have received doctorates or the equivalent in science, technology, engineering, mathematics, or other fields of national need from qualified U.S. institutions."
• "Ensure that the United States is the premier place in the world for innovation. This can be accomplished by actions such as modernizing the U.S. patent system, realigning tax policies to encourage innovation, and ensuring affordable broadband Internet access, the report says."

The report outlines clear steps for improvement. Some are controversial, for instance there are international development issues to promoting a policy of siphoning off the most promising students from foreign countries, nevertheless, for the most part these seem straight forward. However, importantly, there is no sense of buy-in from many politicians. Thomas Friedman's New York Times today (accessible to subscribers), "Keeping Us in the Race", criticizes the administration's priorities:

"This is where President Bush should have focused his second term, instead of squandering it on a silly, ideological jag called Social Security privatization."

Friedman's admonishment seems mild and understated relative to the ballooning expenses of the administration's charge into the Iraq war and bullheaded insistence on tax cuts as well as its relentless rhetorical focus on terrorism and values. No doubt others have harsher criticism. In addition, the current guised creationist chatter and distracting court proceedings for teaching "alternative" theories of man's existence on earth do nothing to bolster public confidence in science. If anything a large swath of the population may be enboldened to eschew the challenges of learning science.

While it's clear that the administrations focus is not on education it's not clear what the public sees as administrations priorities. Purusing a series of polls over the last couple of years shows that while "economy and jobs" constantly rate as a worry to pollees, education generally is one of the last priorities, while gas and energy, terrorism, healthcare, Iraq and periodic crisises such as Hurricane Katrina are always prominent concerns. Interestingly "jobs" and "education" are always broken out as two separate priorities in the polls, which skews the fact that they are dependent upon each other. "Jobs" usually rates high and "education" rates low.

The agenda not only faces challenges from the administration and public perception, it doesn't seem that science holds the allure for students that it once did. While science and math are interesting pursuits, many undergraduates opt for easier and more lucrative paths in economics or business. Though it's a cynical view on these important goals, their choices aren't lazy they're sage. Just as it's savvy for businesses to off-shore technology and manufacturing, in kind, it's smart for undergraduates to recognize the often limited job opportunities and financial incentives to majoring in science as opposed to business. In a world where any young cool performer or slob with some Karaoke practice and a song can have a shot at launching a lucrative record career from "American Idol", wealth is king. There's no nobility to being a poor researcher renting the smallest house on the block in order to fund serial post-doc positions.

While science education and technical prowess is clearly important to scientists and ultimately to our nation's ability to compete, there seem to be more pressing priorities for the public, politicians, and students. We admit to being disheartened, but without serious political will we don't seem poised for any immediate attention to these goals. All indications are that the political priorities, both practical- budgetary and ideological, at the federal and state levels are attuned to other goals that either compete with or trump attention to science education and international competitiveness.

Progress

The total number of malaria infections worldwide is greater and more widespread than what epidemiologists predicted when they took stock of the situation few years ago. Malaria continues decimate populations of Africa. The persistent morbidity and mortality from malaria is a multi-faceted challenge with far reaching problems such as increased drug resistance in the parasite Plasmodium falciparum, poverty that exacerbates health problems, and inconsistent and politicized efforts to irradiate the disease. With global temperature change threatening to increase the number of mosquitoes, the urgency for malaria vector control and disease treatment only increases.

On its face progress has been good. Efforts to treat and prevent infection and death have made inroads on many fronts. multiple fronts. The parasite was sequenced several years ago and there is a lot of research funding dedicated to finding better drugs, methods for prevention and vaccines. But although there is an excellent array of promising technologies there is a lack of consensus about the use of existing technologies. Available methods for mosquito control are not employed because of science, politics, economic development and research funding quagmires. There are competing agendas between all parties; researchers, pharmaceutical companies, government agencies and public health experts. On one hand the competition between various parties is helpful for assuring success via one method or another, but it also interferes with actual treatments for people who live in the malaria infected areas.

Politics

Various players all sincerely want to see malaria irradiated but can't cease bickering about the solutions. For example, bed nets have long offered a promising low tech method of malaria control. Permethrin impregnated bed nets are cheap and and easy to distribute and studies have shown that they can decrease deaths by 20%. However for several reasons, only one in 20 children uses the nets. Typical to many efforts, funding is often scarce or erratic. Political stalling in distributing available funds is typical when aid is tied to policies that recipient countries don't agree with.

As if these problems weren't challenge enough, the bed net advocates seems to be directly at odds with the DDT advocates. The DDT contingent argues that spraying will irradiate mosquitoes. DDT is endorsed by the the military and others. Defenders of DDT disparage the proposals for bed nets. Reason magazine disparaged bed nets in a recent article because "bed nets protect only at night". The truth is that mosquitoes are actually only a threat at night. Incorrect politically motivated ideas like this interfere with finding a solution to the problem.

Qinghao Shortage?

Another example of complications with available technologies involves the artemisinin derived drug Coartem. In 2001, the WHO approved use of this drug from Novartis. The drug combines an artemisinin derivative harvested from the qinghao plant indigenous to China, with a second drug - lumefantrine. The artemisinin combination therapies (ACT) have proven to be the most effective treatment, as older treatments are increasingly ineffective against drug resistant strains. As a result reliable artemisinin sources are high in demand.

Today, for the second year in a row, Novartis, the sole producer of the drug, reported that its supply of Coartem will not meet its production goals. This year the company will only supply 13 million doses, instead of an estimated 30 million needed. Novartis says it received too few orders in time to produce the quantity needed, and also that it has had have problems obtaining the plant, because Tonhe, a Chinese company contracted to supply the qinghao, can't acquire the plants it promised because farmers are selling their crops to better paying local Chinese companies.

Unfortunately Novartis ran into the same shortages last year. At the time, they were chided by the World Health Organization (WHO) for the mishap). In a letter to the editor in response to an article about the dispute a Novartis VP and General Manager of Malaria Initiatives wrote to the Financial Times.:

"Sir, Contrary to the headline on your recent report "Finance Dispute Halts New Malaria Treatment Project (February 19), our partnership with the [WHO]...continues to move forward rapidly...In response to recent exponential increases in demand, Novartis has rapidly scaled up production capacity and expects to be able to produce 30m Coartem treatments this year...." (March 3, 2005)

But when the time came, Novartis again failed to deliver for unknown reasons. Sanofi-Aventis has recently announced plans to produce a artemisinin based treatment next year in a joint research and development agreement with the Drugs for Neglected Diseases Initiative (DNDi), a research group based in Geneva. Hopefully the added competition will change the dynamics of production, although if there is a shortage of the plant needed, arguably more competition won't solve the problem.

Vaccine

Almost everyone agrees that infection by Plasmodium falciparum will be easiest to prevent with a vaccination, yet this too remains an elusive goal. A study last year in Mozambique done by University of Barcelona and GlaxoSmithKline showed good initial results. Another study done by Oxford looked promising but fell through last year -- to their credit Oxford group has published a follow-up study about the failure.

While vaccines are the ultimate solution, we are a world of limited resources and ever burgeoning populations of people and infectious diseases. Are we attached to the idea that no disease can be controlled without a vaccine, even as malaria and other diseases could be controlled with other available technology? Vaccines attempt to circumvent politics and competing ideologies This works as long as vaccine development doesn't get stuck in the very same political quagmires.

Acronym Required previously wrote about new schemes for vaccine funding here, and writes frequently about public health.

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 Global Fund caused a stir last week by pulling out of Myanmar. The move will phase out funds for HIV/AIDS, tuberculosis, and malaria, cutting off 98.4 million dollars slated for the country over the next 5 years. About 12 million dollars has already been disbursed but will most likely be retrieved by the fund.

The agency says that Myanmar's AIDS epidemic is one of the most severe in Southeast Asia and is complicated by concurrent rises in tuberculosis infections and drug resistant cases as well as limited access to anti-retroviral drugs. Infections have spread beyond high-risk populations and now approximately 2% of all pregnant women are infected with HIV. In addition the country has the highest TB rates worldwide according to the agency's figures, and 71% of the population is at risk for malaria, a disease that is responsible for 3,000 deaths and 600,000 victims yearly. The mosquito born disease tops all causes of overall morbidity and mortality and is the biggest cause of death in children under five.

The Global Fund quit its efforts to work with the military junta, because the government has been increasingly restrictive of the agency's goals, has limited access to victims, and interfered with the importation of essential medicines. If Mynamar wanted to work with the Global Fund in the future the organization said; "...there has to be a substantial change in the attitude and in behaviour towards national and international humanitarian work." The world waits.

The dire straits of the public health situation originally motivated the substantial funding allocations, despite the Global Fund's concern that the government wouldn't be transparent or trustworthy enough to use the aid appropriately. When Myanmar backtracked on its promises in several areas the organization finally decided to leave, publically noting that it was Myanmar's actions, not outside pressure, that motivated the agency's decision.

Yet it is impossible to ignore the political background in which the decision was made. The White House, the US Congress and US Secretary of State Condoleeza Rice have all voiced frustration at the persistent lack of movement by Myanmar towards democracy. The junta has long been condemned for its violations of human rights. Political prisoner and Nobel Prize winner Aung San Suu Kyi fights resolutely to draw the world's attention to the atrocities, while Myanmar has repeatedly defied threats and warnings from the US, Canada, Japan, Germany and others, habitually making short-lived promises under international threat of sanctions or political ostracism, then retracting its vows later. Most recently it chose to cede its position on the Association of South East Asian Nations (ASEAN) rotating chairmanship to "focus its attention on the ongoing national reconciliation and democratization process." Reflexively, individuals and nations are cynical about the sincerity of the statement.

As Myanmar has dodged pressure, US policy towards aid - even for the most devastating infectious diseases - has swerved to reflect the political tenor of the administration. The US announced earlier this summer that it wouldn't send HIV/AIDS aid to any country that didn't condemn prostitution, a move decried by many public health officials, and remained resolute in spite of challenges from Brazil, a economic powerhouse compared to most aid recipients. The Global Fund move may be an independent decision but it resonates easily with current US foreign policy trends.

In the larger context there is a general and longstanding debate about aid, fueled by fervent disparate beliefs about its usefulness. Tied and untied aid is granted for various reasons but generally humanitarian aid philosophy tends to fall between two extremes. There are those who insist that all victims - of wars, disease, political malfeasance and natural catastrophe should receive aid regardless of the political context. To do otherwise they insist, is unconscionable. At the other extreme are those who say that aid is futile and too often recipients are characterized as "innocent victims" - when in some horrific situations much of the adult population is culpable. This stance insists that aid money does nothing except further enable entrenchment of systemic problems such as brutal dictatorships, intractable wars, or even natural catastrophes. While the actual approaches taken by governments and NGOs are more often constructed of subtle variations in these extremes its hard to find any compromise that isn't injurious to some parties, usually the most helpless.

Despite one's views, the fact is that hundreds of thousands of people in Myanmar are relentlessly poor, hungry, and will be further devastated by the decision, even when other aid agencies pledge to step in to fill the gap. The rhetoric from US democracy building affiliates like the IRI urges the Myanmar people to free themselves. Says former deputy Secretary of State Lorne Craner: "I will say it's the people inside the country (Burma/Myanmar) that will cause the change - not because Washington wants something, or London wants it". Pragmatic perhaps, except for the perverse reality that a repressed malnourished, demoralized population seems hardly capable of summoning the vigor necessary to demand democracy. We hope for improvements in the medical situation, since AIDS, TB and malaria are largely controllable via technology, but the endless rampage of these diseases, is highly effected by politics of all stripes.

Suketu Mehta received enormous praise and some criticism for "Maximum City", a non-fiction book about Bombay. The Economist said about the book:

"Suketu Mehta tells the stories of slum-dwellers, dancing girls, hitmen, and poets, all of whom have come to Bombay to make it. With a clear but non-judgemental voice, his is an outstanding tale of the exhilarating city in which he grew up."

Suketu Mehta boldly highlights a "clear but non-judgmental voice" on his website. This week the author uses his platform to opine broadly in the New York Times about the outsourcing of jobs by the West to India. With the media chirping daily about outsourcing, Mehta portrays American workers handwringing over their lost jobs in A Passage From India". He speaks again with a clear voice but this time he is decidedly judgmental.

It is admittedly difficult to argue with the article since it touches on many sides of a complicated issue from a variety of perspectives and voices. Mehta masterfully spins bits of truth into an argument that cossets our fears with gentle conciliatory gestures. On one hand he provides easy examples to illustrate what we already suspect are our national failings. "In this year's national spelling bee", he says, as we succumb to the idea that our children are getting dumber;"the top four contestants were of South Asian origin"".

Mehta was apparently educated in English schools in Bombay, moved to New York when he was fourteen and graduated from NYU and University of Idaho Writer's workshop. He portrays himself in the image of a Pico "Iyer-esque" cosmopolitan - a trans-continental city denizen, who finds friends and family in the many "..rooms" in Paris, San Francisco, Bombay or New York. From this position, he contends that the education in the West is inferior. "If I were now to move with my family to India, my children - who go to one of the best private schools in New York - would have to take remedial math and science courses". Then he lines up his evidence to assert that this is the cause, which can be linked to an effect; "one in 10 technology jobs will leave these shores by the end of this year". The result, he concludes, leaves the West poised to plummet noisily to "their" (third person) demise - "complaining when their jobs are being lost to children of the empire who are working harder than they are." Does he suggest that perhaps the West deserves the outsourcing as some sort of come-uppance?

Mehta then assumes the role of the underdog when he appeals to our guilt at a time when many of us question our oafish international behavior: "I was mercilessly bullied during the 1979-80 hostage crisis, because my classmates couldn't tell the difference between Iran and India". He scoffs our slothful habits, "Indians have had to learn; we have had to slog for long hours in the classroom while the children of other countries went out to play". He strings it all together onto a history of imperialism; "Why are Indians willing to write code for a tenth of what Americans make for the same work? It's not by choice; it's because they're still struggling to stand on their feet after 200 years of colonial rule." It's not clear whether the author is speaking for an India that perhaps as a nation has a chip on its shoulder, or whether he's reflecting some personal bitterness.

Is he an outsider to all nations, uncomfortable in a quest for illusive identity? Or is his position enviable, maybe uniquely fortunate, in that he can assume multiple identities but be caged by none. Perhaps his multi-lingual, multi-cultural identity positions him well to elude the vagaries of globalism. Regardless, he glibly assumes different personas, donning the robe of the worldly elitist to scorn us, then the scuffed shoes of the beleagured exile to rebuke us, before assuming the mantle of dutiful American: "I have a vested interest in seeing America prosper. But I am here because the country of my ancestors didn't understand the changing world..". Continued protectionism, he warns; "will ensure only that *our* schools stay terrible; it'll be an entire country run like the dairy industry, feasible only because of price controls and subsidies". We are left to peer quizzically if doubtfully into the mirror that he holds up for us, re-examining the blemishes that he highlights.

Meanwhile, the author embellishes not only India's education system but its technological abilities with select evidence; "During the technology boom of the late 1990's, Indians were responsible for 10 percent of all the start-ups in Silicon Valley". This he uses to hint at inevitable dominance - "Those Indians who went to the United States...have done remarkably well: Indians make up one of the richest ethnic groups in this country". As deftly as a Bollywood script writer, he adds magnificence, bright colors, shiny sparkly glory, and a bit of song and dance to create the glittering myth of India Ascendant

Then, having drawn the line down the middle and deftly balanced the two sides with some well worn arguments and classic handicaps he concludes "The outsourcing debate seems to have mutated into a contest between the country of my birth and the country of my nationality." Finally, after ever so politely, apologetically and properly putting the ambiguous *us* in our place, he offers nobly that; "Indian-Americans can help..deal with the emerging economic superpower that is India".

It is interesting how the gritty picture of Bombay in "Maximum City" opposes the shiny glossy composite of the ascending India (a sleight of even-handedness) in this article. Shall we trust the words of this benevolent self styled avatar of global understanding? What is true? Are U.S. schools failing abysmally next to India's? Are we losing our scientific edge as abruptly and tragically as a child misspells some impossible multisyllabic word presented in a spelling bee? Is the trend in outsourcing proof that India is just a hop skip and jump from becoming "the empire", the "economic superpower"? Should we be shaking in our temporarily well-heeled boots? Could we possible answer all these questions?

(To be continued)

"A Fine Balance" is also a book about India by Rohinton Mistry.

In the summer of 2003, at yet another symposium dedicated to struggling with the reality of the tenacious poverty and diseases of the millennia, the Bellagio Study Group on Child Survival estimated that each year, 6 million children in 42 countries where 90% of child deaths occurred in 2000 could be saved; if only 23 proven health interventions for common ailments and diseases were deployed.

But this month, as pleas for more aid echo throughout the world, the UN reports that the basic development goals are still not being met:

"Slow economic growth, poor trade performance, continuing environmental degradation, debilitating HIV/AIDS pandemic, discouraging foreign direct investment and unmet ODA (overseas development assistance) commitments, compounded by a host of new challenges in a globalizing world make the development tasks of these countries extremely difficult," UN Under-Secretary-General Anwarul K. Chowdhury told a symposium on the global development agenda at UN Headquarters [June 1, 2005].

But while at the UN and conferences like Bellagio see the feasibility of improving childhood morbidity and mortality, not everyone's so sure. "Can the world afford to save the lives of 6 million children each year?", the medical journal Lancet (subscription) asks in a follow-up to the Bellagio study in their June 25th issue. And what's the cost to developed countries?

"US$5.1 billion in new resources is needed annually to save [the] 6 million child lives in the 42 countries [of the Bellagio Report]. This cost represents $1.23 per head in these countries, or an average cost per child life saved of $887. Sensitivity analyses for salary levels for community delivery agents, drug costs, and coverage rates for 2000 were used to develop uncertainty estimates around the US$5.1 billion annual price tag that range from about $3.1 billion to $8.0 billion."

$887 cost per child life saved. The article assesses the Millenium Development Goals (MDG) of (among other things) reducing child mortality by two-thirds by 2015, and determines that "child survival is affordable for donors and developing countries". The hurdles will be the "lack of funds" and "scaling up health delivery".

In related news, The Ellison Medical Foundation has been announcing that they will give $100 million dollars to Harvard University to start a global monitoring research center, which will independently measure global health expenditures, delivery of services, and the impact on population health.

The Ellison Foundation was dedicated to aging and global infectious diseases however they have dropped the global infectious diseases focus to target areas that are 'less well-funded'. [Headline philanthropy may be even more competitive than the software industry].

There have always been debates about aid for development and disagreements about the ideal aid mechanism. For now, aid and global health initiatives are routinely justified via different sorts of cost-benefit analyses. Unfortunately the models, though necessary, are sometimes necessarily limited -- a vaccinated child does not only save himself, for instance, but the costs of care for those he may infect if unvaccinated.

Even more ponderous then methodological questions are the ethical considerations of this type of economics. For example, within the apparently burgeoning cost-benefit analysis industry, how are the cut offs discerned? At what point is a certain life, to some, just not worth donating to? Perhaps it's not the $887 determined by the Lancet study, but something more - $889? - or less? - Despite proclamations about a culture of life? Or will we be consoled by ever more precisely balancing the cost of others lives- in order to ever so quietly bear with poverty and death on other continents? Do the goals behind the millions that will be spent for cost benefit analyses dare to propose to change anything?

Africa's AIDS Campaigns - Time for Optimism?

It's hard to be optimistic about the subject of HIV/AIDS. India, Russia and China, are in various stages of epidemics and denial. Caribbean and Africa populations and economies are devastated by the disease. Statistics on South Africa's AIDS epidemic show that by 2003, 5,300,000 people were living with HIV/AIDS and 1,100,000 children were orphaned as a result of the disease. The statistics, however, are too low. 370,000 AIDS deaths were predicted for 2003, but the actual registered deaths turned out to be 456.7 thousand. Although statistics show that 21.5% adults (15-49) in South Africa are infected with the HIV virus, in some regions and among child-bearing women the rate is as high as 37%.

Most people acknowledge the news as depressing. However David Brooks, columnist for the New York Times is more optimistic. Brooks recently traveled through Africa, toured hospitals and sent his observations from Windhoek, Namibia. Brooks was cheered, he wrote in his editorial, to "run across health care workers", or "run into people like the 6-year-old daughter of AIDS afflicted parents who named her "Haunapawa" (which means 'there's no good in the world'), or "run into scenes..[where] patients can wait eight hours..to receive medical care and counseling."

But despite what seems like overwhelming misery Brooks says: "..you expect, or at least I expected, to find unrelieved sadness. But something positive has happened recently because of the confluence of three factors...The first is the spread of antiretroviral treatment programs." Mr. Brooks notes that "...the U.S. and other countries are pouring in money to pay for treatments". He's right to note the improvements. But overreaches by suggesting: "there's something perversely akin here to Silicon Valley in the early 1990's..."

Brooks paints a new picture of Sub-Saharan Africa, not of a grim land of poverty, 40% unemployment and whole villages being wiped out from AIDS, but a of a place like Silicon Valley, where money flows in the streets, AIDS drugs for all. Just like free soda and snacks during the dot com era?

Reality, An Uphill Battle

Contrary to Brooks' comparison however, there's little to associate the flood of dollars looking for lucrative investment during the dotcom with AIDS aid to Africa. Only 8% of people who are infected have access to anti-retrovirals, while millions have no access to medication.

Brooks says:"African governments have gone on the offensive against the disease." However in some places, such as South Africa the opposite is true. Health minister Manto Tshabalala-Msimang went on the offensive not on behalf of AIDS patients, but against pharmaceutical companies with drugs. Under intense pressure nationally and internationally, she reasoned in August 2004, just months ago, after years of denial about HIV and AIDS, that the government was "soberly considering" the use of AIDS medicines.

Last month, in a typical flip flop, she resisted urging from the UNAIDS and the World Health Organization(WHO) for more widespread use of antiretrovirals, suggesting instead that people eat well and use "garlic and lemon", olive oil and beetroot. She has repeatedly condemned the "unknown side effects" of AIDS medicines and so convinced populations not to use them.

Other countries have been far more proactive developing an AIDS campaign. Uganda combated the disease head-on, designing a comprehensive strategy that was pushed at the highest levels of government. The "ABC" counted on -- 'Abstinence', 'Be faithful', and 'Condoms', three legs, two of which formed the cornerstone of the Bush AIDS policy.

However a recent study suggested that it wasn't A & B, 'abstinence' and 'be faithful' that were responsible for the decrease in infection rate, rather it was C & - condoms, and even more dire, D - death. The authors note that so many had died in the first wave of the epidemic, a fact that that would make the infection rate decrease the population fell due to mortality.

Brooks observes that the money is flowing in. But many people would argue the opposite conclusion, that the money has not been forthcoming enough. In 2003 Bush pledged $15 billion ($10 billion "new") over the next 5 years for the AIDS crisis. But in 2004, the first budget year of his pledge, Bush asked for only 2 billion dollars from Congress. Congress overwrote the president and approved $2.4 billion. In 2005, Bush sought only $2.4 billion, Congress overwrote that and awarded $2.9 billion.

Not only has the money been parceled out sparingly, aid is stymied by debates around ideological issues. Some dispute the focus of President Bush's money dispersal -- now 20% of funds are funneled to abstinence programs, half of which are explicitly slated for religious organizations.

Organizations that promote condom use have had funding shut off. In a move that has drawn intense criticism, the U.S. has tied aid to pledges against prostitution, which would leave a large percentage of AIDS afflicted populations without care has drawn intense criticism. Donations cannot generally be used to buy generic drugs, only Federal Drug Administration (FDA) approved drugs can be used, and American companies are favored.

AIDs Aid

A recent UNAIDS report about Africa stresses that aid and government action need to be intense and thoughtful. The report outlines three scenarios that would yield possible HIV/AIDS outcomes by 2025. The first would focus on prevention for the least effective outcome, and would cost the U.S. $5-6 billion per year. Another would focus on ART but ignore other pressing issues and the U.S. would spend up to $4 billion a year. The last would attempt to implement what it takes to decrease the numbers of deaths and orphans and the incidence of disease- which would cost the U.S. $10 billion dollars per year.

There are many theories about aid in general, some disagree that aid is affective, some believe that we should spend more - post-haste. Hospitals, hospital wings, and staff is essential. One could reasonably argue that there is an "AIDS industry". However, for those who believe there is too much money going to Africa, Jeffrey Sachs of Columbia University's Earth Institute responds:

"The U.S. is not pulling its weight right now." "[There is] a great myth in the US [about aid], the problem is it's on such a small scale that it's not commensurate with the challenge."

The U.S. provides the smallest amount 'of development aid of the world's 22 wealthy nations, about 15 cents per day per American'.

Often economic considerations such as return on investment ROI couch aid as some kind of sweet business deal that's plugged in pithy marketing campaigns with a dollar signs scattered throughout as often as periods. Like any complex problem, the outcomes of the AIDS epidemics are complicated. While they can be modeled economically such analysis too often ends up as a spending debate, shall we spend this money or not? Let's not. Action on climate change suffers a similar fate.

Optimism?

Do we have reason to be optimistic when places like South Africa struggle with "crumbs" of international private investment. Despite the depressing picture, the history of HIV/AIDS shows that in the endless series of set-backs, punctuated by halting steps forward, optimism is essential -- even though it might not be Brook's brand. Here are some reasons to be optimistic:

• Three years ago antiretroviral treatment (ART) was still shunned in favor of abstinence, on cost and ideological grounds. That's slowly changing.
• Four years ago treatment costs became feasible, largely because of generic drugs manufactured in countries like India and Brazil, often in defiance of US and international patent regimes. The generics are easier to administer as well as being more affordable.
• South Africa's president Mbeki is slowly being convinced that the HIV virus does cause AIDS, although from the sounds of it maybe the Health Minister is now shilling for him.
• In 2001 South Africa won a major lawsuit against U.S. pharmaceuticals over patent rights for essential medications.
• Brazil's experience keeping its AIDS epidemic in check in the 1990's and early 21st century via universal treatment programs and staunch national and international political determination was a beacon of hope for developing countries.
• Strong leadership from NGO's and organizations like the Clinton Foundation, paved the way for acceptance of ART treatment, even as many apologists claimed treatment wouldn't work because of transportation hurdles, costs, culture, protocol adherance, corruption, health infrastructure and lack of training.
• Brazil, Thailand, Uganda and Senegal, geographically distinct countries with very different challenges and populations, each managed a level of success because at the highest presidential and cabinet levels there were strong commitments to their programs. There was a sustained determination to combat AIDS. Their heads were out of the sand. Women were an integral part of the solution, as was treatment for all populations, testing, education, and money.
• The United States is contributing money, expertise and counsel to the efforts.

Brooks concludes at the end of his article:

"[I] now realize we should be redoubling our efforts out of a sense of opportunity. I came aware of controversies about abstinence versus condoms in AIDS prevention programs, about U.S. aid versus multilateral aid, and now realize that all that nonsense is irrelevant on the ground."

This is hopeful. Its easy to be discouraged to the point of ineffectiveness because the grim facts lead people to dismiss Africa as a lost cause. The endless spectacle - "orphaned AIDS victims" - tug endlessly at our heart and purse strings. The effect is numbing. However the solution requires our full-fledged, reality based commitment. It has been said that HIV/AIDS is one of the biggest challenges of our century. Optimism feeds determination, feeds activism, feeds success.

Jonas Salk's research led to the use of the deactivated polio virus to inoculate and immunize children. The first large scale vaccinations took place in Cuba, where Fidel Castro welcomed the vaccine, which at the time aroused suspicion from western leaders. Since then, the polio vaccination effort has progressed in fits and spurts. In the 1960's researchers discovered SV40 contamination of the vaccination, that elicited fears about safety. But over time the effort steadily gained momentum. In 1988 the World Health Assembly led a worldwide program to eradicate the disease. It worked. In 2003, the World Health Organization (WHO) reported fewer than 700 cases worldwide, down from 350,000 in 1988.

Yet the history of polio has shown that infectious disease eradication is challenging even with an effective vaccination. The majority of polio cases occur in more remote regions of the world, where people have little access to running water, sanitation, food, or basic health provisions. Poorer countries are challenged from distributing vaccines with refrigeration and transportation difficulties. Ice packs chill the vaccines effectively, but need to be refrozen. In rural areas where basic amenities like electricity are scarce, this is sometimes impossible. Transportation to distribute the vaccines is difficult in remote terrain especially where vehicles can't pass. Accurate records of vaccinations need to be maintained and villages need to be notified of upcoming vaccinations and convinced that the medicine is safe for their children.

The World Health Organization (WHO) reports that from 1998 to 2003, "the world's largest public health campaign", spanned 200 countries, employed 20 million volunteers and consumed $3 billion dollars via the Global Polio Eradication Initiative. In 2003 the WHO was confident that all the effort would pay off since only six countries remained polio-endemic: Nigeria, India, Pakistan, Niger, Afghanistan and Egypt. Doctors predicted that polio would be successfully eradicated by December 2005, a postponement from 2002, which was a postponement from 2000. Polio has recently re-emerged in eleven countries. In four of these countries the recently reported outbreaks were imported virus due to migration or travel. Yemen reported 179 new cases and Indonesia 2 new cases in the past week.

The new outbreak is being traced to Africa where several countries blocked vaccination programs in 2003-2004. Officials in Nigeria for instance, began to suspect polio vaccines were a plot of Western countries against the fertility of Muslim girls and halted their vaccination campaign. In Mali 11 were jailed for not allowing citizens to be immunized for religious reasons.

This was the last push of the campaign before the deadline. The good news is that the number of cases worldwide is small. But at this stage of the campaign, the cost to treat each subsequent case increases significantly. The effort requires constant vigilance. In India, where polio is indigent, 24 million or so births per year require that many new vaccinations. Adding to the difficulty, India's resources allow less than $4 per person to be spent on health care -- other African countries can spend half that much.

The high costs of the current effort invites cost benefit analysis by health economists and public health officials, who estimate that as many as 5 million cases have been prevented, however; the remaining cases could cost as much as $600/case. Some argue that the money to treat these remaining cases could be spent on basics like electricity or sewers (sewage is often the source of the virus).

Sometimes eradication via vaccination seems elusive, always 6 months out of reach. But ridding the world of polio -- crippling scourge of a virus that it is, will always be worthwhile goal.

Three diseases with the highest human and economic toll are malaria, TB and AIDS. Almost all malaria infections, more than 95% of new tuberculosis cases, and 95% of HIV infections occur in developing countries. The latest figures from Global Health Reporting count 39 million people worldwide infected with HIV, 300 million with acute malaria, and 15 million with TB. Treatments or prevention of these diseases are expensive, easy to abandon after ambitious pronouncements, and inevitably mired in multi-national politics. For many in public health arenas vaccinations are the most practical way to solve the problem, even if vaccine development is a scientifically challenging, long- term solution.

Public health challenges generally fall through the cracks of traditional market solutions because there is little financial motivation to solve these expensive, multi-faceted and politically cumbersome problems. This is particularly true for diseases that are present in countries in Africa and Asia. Malaria has been a killer in Africa and Asia for as long as we remember and prevention and control mechanisms have failed.

Only part of the failure is due to technology, however a vaccine offers a way to potentially cut through all the failures to stem the disease. The broad and all encompassing concept of a 'failure of the markets' occurs because for-profit pharmaceutical companies, almost exclusively based in the United States and Europe, have no incentive to research, develop drugs or treat diseases that are only prevalent in developing countries. According to one report by Medicin San Frontiers, 1393 new chemicals were developed as potential drug targets from 1977 through 1999. Of these, 13 were for "tropical diseases" (a group of diseases largely confined to tropical regions including, Dengue Fever, Cloroquine resistant Malaria, TB, Leprosy, Chagas, and others). Six of these thirteen were for military use. Drug development looks at potential profit not potential lives saved.

While vaccine development promises to circumvent a lot of entrenched problems it's susceptible to its own set of problems-- and also financing. The Wall Street Journal reports on funding initiativesin in the works that help finance infectious disease drug development in developing countries. In an April 26, 2005 article titled "Malaria Trial Could Set a Model For Financing of Costly Vaccines", the paper reports on several private/public funding collaborations to finance costly drug development. The hope is that these new financing models can "...step[] in where market mechanisms have failed".

There have been numerous proposals over the years aimed at lowering drug development costs by promoting research and collaboration between often competitive agencies. This effort is promising, according to the Wall Street Journal because it aims at two of the most problematic impediments to funding, the hesitation of drug companies to front research that they won't profit from, and the hesitation of individual countries to fund highly expensive public health initiatives for developing countries. The article highlights efforts to establish the International Finance Facility (IFF), by a group of European countries -- the US will not participate-- via government bonds:

"...floating government bonds geared specifically to supplying poor countries with available vaccines...countries go to the international bond market to obtain funds to speed up the purchase of existing...[and] new vaccines."

The Global Alliance for Vaccines and Immunizations (GAVI) also contributes to the IFF immunization project. The article describes a malaria initative for vaccine research project at GlaxoSmithKline PLC's GSK Biologicals unit in Belgium that after a long delay is now in clinical trials in Mozambique to test children using the newly developed vaccine. The effort had been abandoned due to a funding quagmire but has been revived through these collaborative funding efforts.

The second scheme being used to fund vaccine development involves "advance-purchase contracts", through which pharmaceutical companies are paid to develop medicines in advance. The idea was proposed and modeled by economist Michael Kremer. The contracts aim to motivate pharmaceutical companies to develop vaccines. It insures that the companies who bring a vaccine to fruition are reimbursed for their development efforts.

Of course, in addition to these ideas, there are others. The various alternative plans reflect the inevitable uncertainty that hovers overs any research efforts as well as dynamic politics, ever changing financial priorities, and . Senators Frist and Kerry introduced a bill in 2001 that would have allowed tax incentives for the development of infectious diseases. The Global Alliance for Vaccines and Immunization (GAVI) combines contributions from private sources such as the Gates Foundation, WHO, NGO's, and research organizations, with funds from national governments The organization strives to promote standardized resource allocation.

Of course their are concerns with the proposals. Some organizations that are involved with current prevention efforts like the Global Fund Global Fund's HIV/AIDS, TB and Malaria projects have concerns that the vaccine initiatives will distract the efforts of current prevention efforts like bednets.

A recent World Changing post reacts to a CRN (Center for Responsible Technology) blog entry on the potential uses of nanotechnology. The World Changing essay warns against focusing on technology as the perennial silver bullet to societal ills, and is especially critical of "technophiles" who tout future technology in lieu of taking viable action today. As an example; why focus on nanotechnology to solve malaria problems when mosquito nets that are currently available can be used to help prevent this serious disease?

The point is well taken, certainly it's nice to see people coming around to articulate this, though it seems at first glance that CRN's blog is a somewhat weak rhetorical launch pad for such an argument. So we could leave it at that, but the World Changing article and its juxtapositon to the CRN article bring up some points. The World Changing article strongly distinguishes between two types of "technophiles"; "technoprogressives", and the others;

"market libertarian technophiles who like to handwave about abstract indefinite futures in which injustice will somehow evaporate so as to help justify their own ugly indifference to injustice today".

With a flourish of typing and disdainful curl of the upper lip, the author categorically divides the sage "progressive" from the ignorant "libertarian" technophiles. It's catchy and tempting but...