Impolite Company

The Swine Flu Mother Lode

Effect Measure put up a post yesterday that included a link to the Mac Daddy of all swine flu resources, H5N1:  News and Resources about Avian and Swine Flu.  I'll probably mainly follow Effect Measure, just because it's relatively condensed whereas H5N1 may be a little too rich for my blood for every day consumption.  Still, if you want a place to go to find the real loot on the swine flu, go there!  Here's a little bit from a recent post, Pandemic:  Come as You Are, Dumb as You Are:

Stress, we hack novelists know, is the key to revealing character. So it's discouraging to see how little stress it takes to reveal a serious lack of character, not to mention basic common sense, in our political masters.

The Iraqis, after six long years' experience with irrational and pointless violence, shoot the three wild boars in the Baghdad Zoo. Just to make sure. (Why didn't they shoot all their chickens back in 2006 when they actually had a couple of human H5N1 cases?)

The Egyptian government is slaughtering all the pigs, who belong to Coptic Christians, while the Copts and cops get into punch-ups about this policy.

China, home of a large fraction of the best minds on the planet, has banned Canadian pork imports.

Human Influenza Virus?

Effect Measure reports in a recent post that we may have the order of transmission wrong--the virus may have originated among humans and we may be passing it on to the pigs, Swine Flu:  Humans, a Dangerous Species:

A farmhand who traveled[sic] to Mexico and fell ill upon his return apparently infected the pigs with the H1N1 influenza virus, said David Butler-Jones, Canada's chief public health officer.

“So far, basically what we're seeing in the pig is the same strain as we see in the humans,” Mr. Butler-Jones said.

“The concern is that if it's circulating in a pig herd, that any other humans that come onto the farm might be exposed and be at risk.”

We still don't have an exact understanding of where this virus came from and are still understanding it's make-up.  As Denise said in reply to an earlier post, not every health crisis can be blamed on factory farms and I think the flu outbreak we're seeing is one that can't be blamed on CAFO's.  Aside from the health aspect of this story, this is a very interesting example of how viruses can travel back and forth between species.

Swine Flu and Industrial Farming of Pigs

The other day, a friend of mine asked me about the possibility of a link between swine flu and CAFO's.  I'd seen some buzz around the sustainability and organic corners of the internet and forwarded a post by Tom Philpott in Grist, Swine Flu Outbreak Could be Linked to Smithfield Farms but with the huge caveat that I didn't see any real evidence that lead to his speculations.  I told her that was the reason I hadn't posted any of that stuff on ImpCo, because I didn't see anything other than finger-pointing without evidence.  Now the Columbia Journalism Review has posted a nice little summary of the action on the Swine Flu/CAFO front for any of you who want to look at the vacuum of information, the tiny little bits of evidence and the discussion in the mainstream medium over the possibility of a connection between swine flu and huge pig operations, Swine Flu and CAFO's?

Clearly, it is too early to make bold pronouncements about CAFOs’ role in abetting the epidemic that has now spread to seven countries. As a front-page article in The New York Times on Wednesday pointed out, even “La Gloria may not, in the end, be the source of anything.” And Yulsman, who originally chided the press for ignoring factory farms, wrote a follow-up postdecision to slaughter all of the country’s 300,000 pigs despite no confirmed cases there, or an article in criticizing CNN’s Headline News for hyping the threat they pose. Many worry that jumping to conclusions can lead to panic or incite unnecessary and costly control measures. (Take, for example, Egypt’s The Washington Post about the threat to the global economy.)

That said, now is the perfect time for journalists to begin investigating CAFOs in a responsible fashion. That means doing things a little differently than the early blog posts, which tended to have a finger-pointing tone, did not deliver much context about evidence and controlling for alternative hypotheses, and did not call experts to test their theories.

The Flu Wiki

As the Swine Flu situation continues to develop, I'll keep trying to post links to good sources of information, both on the basics of disease transmission and so-forth and on the ongoing situation.  Effect Measure has posted a link to The Basic Science of Flu Wiki, a resource for all the basics and more.  They've also got a segment of the Wiki devoted to current events in flu, The Flu Wiki Forum.  There are plenty of scary numbers out there and plenty of things for us to obsess about if we want to scare ourselves shitless.  These sites give us some context for the situation and I'm convinced that more and contextual information is going to help us keep level heads over the next few weeks.  We need to be both concerned and informed about the possibility and dangers of a pandemic--to be concerned without being informed leads to poor decision-making personally and policy-wise; to be informed without being concerned leads to no one acting soon enough or aggressively enough.  So we need both.  As it has been from the beginning of this crisis, my go-to source of info is Effect Measure.

Michelle Bachmann: The Gift that Keeps on Giving

Minnesota Representative Michelle Bachmann is at it again, flaunting her ignorance before the nation and making vague insinuations that Democrats are responsible for everything that goes wrong in America, including Swine Flu!  In the following clip, she notes the interesting fact that there was a swine flu outbreak back in the 1970's under Pres. Jimmy Carter (and doesn't bother pointing out there was a small outbreak a couple of years ago in Ohio:  Did the California H1N1 Swine Flu Come from Ohio?).  Thanks to Pharyngula for pointing out Bachman's lunacy, thanks to PajamasTV for giving Bachmann a platform and now lets roll the video:

Swine Flu--In Depth Information

I've already spent more time talking about swine flu than I thought I would but this is just a little heads-up to a site that's giving good information that gives you the context to understand the conversation about swine flu from an expert who can explain to lay people.  The site is Effect Measure and a number of notable online resources have referred to it.  For instance, Revere writes about flu pandemics and how you can't track one by assuming that it's going to act like an earlier one in Swine Flu:  Flu Pandemics, You've Seen One, You...:

As we keep looking, we will find cases, so the total will rise, probably on a daily basis. Like poll numbers, it is probably wise not to pay attention to daily fluctuations but look at the big picture. Right now the big picture isn't visible, but with the passage of days or a week, it should become clearer. The current spate of cases could burn itself out as warmer weather ensues. Flu is a highly seasonal disease, for reasons we don't understand. That wouldn't mean we were home free, however. Wherever flu hides in the "off season" (flu does find work in the southern hemisphere's winter), it can come back the following year. Those familiar with 1918 know there seems to have been a milder "herald wave" the previous spring which came back like a freight train in August. CDC is well aware of this possibility and should this outbreak wane will clearly urge and engage in continued preparation in the event this evolves in the same way.

This is analysis from senior public health figures that hasn't been filtered through a sensationalist media source and it's worth your time if you're curious.

A Wild Boar Once Bit My Sister

Okay, I can't really claim any kinship to Eileen Smith of In the Pink fame(?) but she captures the proper amount of hysterical mania we should be feeling over The Swine Flue, Save Yourselves:

To anyone who’s freaking out about the swine flu, you’re not alone. Last night, I called the pharmacist begging for Tamiflu, telling him that I had just been bitten by a wild boar. This morning when I got on the elevator, I quickly pressed close door when someone came running up saying, hold the elevator! and refused to help them when their arm was almost cut off. (Seriously, just wait for the next one.) I’m sitting at my desk wearing a surgical mask and yelling at anyone who comes in my office to get out before they infect me.

And for the uninitiated, the title is a take-off on the credits from Monty Python & the Holy Grail:

Wi nøt trei a høliday in Sweden this yer?

 See the løveli lakes

 The wonderful telephøne system

 And mani interesting furry animals

    The Producers would like to thank The Forestry Commission
    Doune Admissions Ltd, Keir and Cowdor Estates, Stirling
    University, and the people of Doune for their help in the
    making of this film.
    The Characters and incidents portrayed and the names used
    are fictitious and any similarity to the names, characters,
    or history of any person is entirely accidental and
    unintentional.
            Signed RICHARD M. NIXON

 Including the majestic møøse 

 A Møøse once bit my sister ...

 No realli! She was Karving her initials on the møøse
 with the sharpened end of an interspace tøøthbrush given
 her by Svenge - her brother-in-law - an Oslo dentist and
 star of many Norwegian møvies: "The Høt Hands of an Oslo
 Dentist", "Fillings of Passion", "The Huge Mølars of Horst
 Nordfink".

Swine Flu Information

There's going to be a whole lotta hoopla over swine flu in the near future--it's actually already started.  I probably won't talk about it much, unless the brou-ha-ha gets too silly and I have to mock it.  But I do think that more information is better and you can follow the links in the follow widget to Center for Disease Control and Department of Health and Human Services resources on swine flu:

How serious is swine flu infection?
Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.  CDC--Swine Flu and You.

New Healthcare Clinic in Austin

Just a quickie:  a new clinic is opening at 1221 W. Ben White Boulevard that will be focused on providing care to those who might not otherwise be able to afford it, as well as providing care for walk-ins.  According to their mission statement, Lone Star Circle of Care Clinics:

“...is committed to the energetic and steadfast pursuit of quality, accessible and sustainable primary healthcare for Central Texas residents, focusing on the uninsured and underserved.”

Simply Austin had this to say in a blog post on the opening:

Lone Star patients are charged on a sliding fee scale based on income, but “we don’t deny care to anyone based on the ability to pay,” Pope said. The clinic, which opened April 7 and has two family practice doctors and two nurse practitioners, also takes patients on Travis County’s Medical Assistance Program, Pope said.

Doctors Discuss Sex, Respect, Violence with Boys and Girls

On a day when my friend George (Toad a la Mode and Toad a la Mode Blog) sent out an email alerting folks to an article in the New York Times about pediatricians talking to boys about sexuality and respect, the Houston Chronicle had an article about gynecologists picking up the abstinence-only slack in Texas in by educating girls about sexuality and confronting the questions the schools are ignoring.  I thought they made a nice pair and so I'm linking to both in this post.

The first one, Another Awkward Sex Talk:  Respect and Violence, looks at how we can talk to boys about these topics without turning it into some Victorian Woman on a Pedestal thing and put sexuality and human needs in terms of respect, trust, and mutual decision-making within relationships:

My friend Dr. Lee M. Sanders is associate professor of pediatrics at the University of Miami Miller School of Medicine, where he takes care of many adolescent boys. “Six or seven years ago,” he told me, “a mother said to me: ‘Listen, there’s no dad in the home and I’m worried about the way I see my son treating other girls. Will you talk to him about it?’ ”

Over time, Dr. Sanders incorporated this conversation into his regular exam room routine, starting with boys around age 12: “We’ll talk about respect, about whether they feel they are respected in their own families, the respect they have for their mothers, the respect they see other men paying to their own mothers or sisters — do you think that applies to other girls that you meet?

The second article looks at how some parents and pediatricians are using earlier visits to the gynecologist in the age of Gardasil as a platform to giving girls a chance to talk about sexuality and ask the frank questions that appear to be choked off in the public school sex education classes, Sex Education Goes to Doc's Office as Girls Get 'The Talk':

Providing medically accurate information can enlighten girls receiving limited information at school, hearing possibly outdated advice from their parents and trading whispers with friends often riddled with misinformation. The American College of Obstetricians and Gynecologists recommends that teens visit a gynecologist for the first time at age 13, 14 or 15 for preventive health appointments that don’t usually involve an internal pelvic exam...After initial questions about Vanessa’s general health, Sinacori escorted Elvia Reyes to the waiting room at her Memorial Hermann Memorial City Medical Tower office. Often, girls will ask more frank questions without their parents listening. Conversation topics range from eating disorders and depression to troubles with heavy, painful periods and acne.

Open Letter to Sen. Patrick

A friend of mine has posted an open letter to Dan Patrick of the Texas Senate over at Reproductive Health Reality Check and I think it does a terrific job of contrasting the gotcha-style, wedge issue driven use of the abortion issue by some on the right with the real, tangible health issues faced by women in Texas every day.  We spend so much time arguing and posing on the abortion issue, time that would be better spent looking for areas of agreement and ways to improve health care.  Check out her post at Hey, Sen. Patrick, Rachel's Mom Needs a Mammogram:

...Senator Patrick, if I've done my math correctly, it seems to me that each year there are at least 11 million women and girls in Texas who AREN'T getting abortions.  Like the 25-year-old woman who had to give up her job in order to be eligible for Medicaid so that she could afford to give birth to her son.  Or the woman who tried to obtain a tubal ligation but was told by her doctor that she was "too young and too fat to have the procedure."  If you're really passionate about women's reproductive health (and here I will perform a gross suspension of disbelief and claim that you are), why do you choose to ignore everything that doesn't have to do with preventing abortion?

I have listened to you and other legislators discuss in great detail the nuances of a clause about whether or not the patient may avert her eyes when her doctor displays the ultrasound.  Meanwhile, Cheryl hasn't had a pap smear in over five years.   And Sharon needs transportation to another town for a breast cancer screening, since she can't afford any of the clinics in the city where she lives.

Sera Bonds--"In Defense of Self"

The Politics of Women's Health in War and Disaster Areas

The following two videos are from Sera Bonds, who spoke at Sun Dragon Martial Arts and Self Defense a couple of weeks ago at the inaugural event of our Fighting for Justice Speaker Series.  Though Ms. Bonds focuses more on the rights and responsibilities surrounding the self defense of individuals in her remarks, she is the founder of Circle of Health International, an organization that goes into war torn and disaster areas and works with the local health care delivery system to try to make sure that women continue to get the health care they need despite often dire circumstances:

COHI defines its target population as women in crisis, specifically partnering with women surviving conflict and disaster. COHI collaborates with locally based, grassroots organizations when invited into a country context to contribute to women's health programming.

COHI provides teams and individual volunteer practitioners such as OB/GYNs, midwives, trauma specialists, and public health professionals with the opportunity to connect with conflict and disaster affected-women as members of international field teams.

This Little Piggy Takes Antibiotics (even though he isn't sick)

Back some time over the past week, Nicholas Kristof posted a couple of reports on possible links between the hog industry and an increase in antibiotic resistant staph infections (MRSA) and the use of antibiotics on healthy animals.  My brother was kind enough to pass the links on to me and I'll do the same for you.  I'm not sure that the links are proven to the point that we should panic yet, but there are plenty of questions about the use of antibiotics in our farm industry and whether that has led to more strains of resistant antibiotics.  These issues should at the very least supply us with another reason to turn a skeptical eye on our industrial farming methods--if the ethical problems of raising animals in concentrated animal feeding operations isn't enough to get you there are plenty of practical ramifications from disposing of the waste, to increased risk of disease and health problems related to animals eating what we think they should eat rather than what their nature dictates.  The articles are:

Our Pigs, Our Food, Our Health on the ties between MRSA and health problems in a small, rural Indiana town.  And Pathogens in Our Pork looks at the heavy use of antibiotics on healthy pigs:

Yet the central problem here isn’t pigs, it’s humans. Unlike Europe and even South Korea, the United States still bows to agribusiness interests by permitting the nontherapeutic use of antibiotics in animal feed. That’s unconscionable.

The peer-reviewed Medical Clinics of North America concluded last year that antibiotics in livestock feed were “a major component” in the rise in antibiotic resistance. The article said that more antibiotics were fed to animals in North Carolina alone than were administered to the nation’s entire human population.

“We don’t give antibiotics to healthy humans,” said Robert Martin, who led a Pew Commission on industrial farming that examined antibiotic use. “So why give them to healthy animals just so we can keep them in crowded and unsanitary conditions?”

The answer is simple: politics.

Thanks, Gibbs.

An Essay on Healthy Eating

It's more than just picking up "organic" products, it involves making the shift away from overly processed foods and the average two pounds of animal products that we consume every day (can that be true?) and to more fruits, vegetables and grains, whether they're organic or not.  At least that's what Mark Bittman of the New York Times writes and I tend to agree with him.  Granted, I favor organics, particularly when it comes to dairy products and I've got a thing for locally produced stuff.  But my love of the local has a lot of different reasons behind it, some related to economics, some to protecting food supply and some just based on quality issues.

The most efficient and far-reaching change we can make in our eating habits that will help our personal health and the health of the planet is to shift away from eating huge amounts of meat everyday.  I still hit the Whataburger now and again and I'll probably never stop eating meat altogether because it's a good treat and it also provides things that are hard to get otherwise without a fair amount of menu planning.  But I have largely turned away from meat as a primary source of calories and I feel a whole lot better as a result.  But why listen to me, I'd like to invite you to read the full essay by Bittman that the following snippet is taken from, Eating Food That's Better for You, Organic or Not:

To eat well, says Michael Pollan, the author of “In Defense of Food,” means avoiding “edible food-like substances” and sticking to real ingredients, increasingly from the plant kingdom. (Americans each consume an average of nearly two pounds a day of animal products.) There’s plenty of evidence that both a person’s health — as well as the environment’s — will improve with a simple shift in eating habits away from animal products and highly processed foods to plant products and what might be called “real food.” (With all due respect to people in the “food movement,” the food need not be “slow,” either.)

From these changes, Americans would reduce the amount of land, water and chemicals used to produce the food we eat, as well as the incidence of lifestyle diseases linked to unhealthy diets, and greenhouse gases from industrial meat production. All without legislation.

Gardasil and Boys and Sex

Merck & Co. is trying to get permission to sell Gardasil to boys--Gardasil is the drug Merck introduced a few years back that was marketed as a protection for women against certain types of cervical cancer.  The cancers develop from certain sexually transmitted diseases and the drug actually prevents those std's rather than directly preventing the cancer itself.  Please allow me a moment to state the obvious:  boys don't get cervical cancer so in vaccinating boys the focus would be on preventing the std's and genital warts.

There's an argument to be made that cutting back on the numbers of people infected with these std's in the general population will reduce the chances of women developing cervical cancer as a result of exposure.  But these are expensive vaccines and the CDC has some serious work to do on the cost-benefit analysis.  But the big cultural question is how the issue is being approached.  Back when states were proposing mandatory vaccinations for girls the big sticking point was whether or not it would increase sexual activity in girls.  But now that the cancer link is weaker, the issue that's dominating the discussion isn't whether it will make boys more sexually active, it's the cost-benefit question.  Interesting how we still have that little double standard when it comes to sex, A Vaccine Debate Once Focused on Sex Shifts as Boys Join the Target Market:

When a vaccine designed to protect girls against a sexually transmitted virus arrived three years ago, the debate centered on one question: Would the shots make young girls more likely to have sex?

Now the vaccine's maker is trying to get approval to sell the vaccine for boys, and the debate is focusing on something else entirely: Is it worth the money, and is it safe and effective enough?

"We are still more worried about the promiscuity of girls than the promiscuity of boys," said Susan M. Reverby, a professor of women's studies and medical history at Wellesley College. "There's still that double standard."

The Deadly Hamburger

Zoinks!  A new study is out saying that folks who eat 4 ounces of red meat, which includes both beef and pork, have a an increased chance of mortality within the next ten years of up to 30%.  Four ounces.  That's a quarter of a pound, which means a Quarter Pounder (or a Royale with Cheese**).  Jill Richardson wrote about the original story, which was in the Washington Post, over at La Vida Locavore and had this to say about the situation, Red Meat Kills:

This doesn't come as a surprise to me, but it's always nice to back up hunches with facts. What I think WILL be surprising to a lot of people is how little red meat (4 oz/day) made a difference. Four ounces is within the Food Pyramid's guidelines for how much meat you should eat daily, although they do encourage you to "choose [fish, nuts, and seeds] frequently instead of meat or poultry." (The Food Pyramid does NOT tell you to avoid beef - just "choose lean cuts" of beef.)

So put down that burger!  But keep in mind that this doesn't really mean that if you eat a burger a day you're going to die within ten years but that your chances of doing so increase.

**Jules: Well, if you like burgers give 'em a try sometime. I can't usually get 'em myself because my girlfriend's a vegitarian which pretty much makes me a vegetarian. But I do love the taste of a good burger. Mm-mm-mm. You know what they call a Quarter Pounder with cheese in France?
Brett: No.
Jules: Tell 'em, Vincent.
Vincent: A Royale with cheese.
Jules: A Royale with cheese! You know why they call it that?
Brett: Because of the metric system?
Jules: Check out the big brain on Brett! You're a smart motherfucker. That's right. The metric system. What's in this?
Brett: Sprite.
Jules: Sprite, good. You mind if I have some of your tasty beverage to wash this down?
Brett: Go right ahead.
Jules: Ah, hit the spot.

Mmmmmm, IMDb!

Screening IVF Children for Serious Genetic Diseases

Genetic Future has a series of three posts spread out over the last few weeks looking at the moral questions surrounding genetic screening of IVF ("in vitro fertilization" for those of us who have to stop and think about what those initials stand for!) embryos for serious genetic diseases.  The conversation spreads to genetic screening in general and, of course, touches on the intersection between certain religious beliefs and such screening. 

I think it's pretty much a no-brainer that once such screening becomes affordable it should become mandatory in the case of IVF where they can test the embryos before implantation and much of the moral huff can be avoided.  Anyone who is willing to undergo IVF in the first place understands that there is an aspect of choice involved in which embryos get implanted and arguing that doctors should deliberately blind themselves rather than find out about risks of severe genetic diseases in specific embryos probably won't be too convincing.  The main problem that comes up is the idea of a slippery slope, that such testing would irrevocably lead to testing for less critical physical traits and then on to some sort of eugenics program.  Enter Gattaca. 

If this debate sounds interesting to you, here are links to the three posts, all of which have plenty of further links embedded and comments to stimulate your thinking:

Embryo Screening Should be Mandatory

Allowing Children to be Born with Severe Disease is Morally Equivalent to Child Abuse

Arguments Against Routine Screening for Severe Disease Genes

Needle Exchange Legislation

Thanks to a post at Capitol Annex, I just learned that Texas is the only state in the nation that doesn't allow some form of needle exchange program to fight against the spread of HIV/AIDS and other diseases.  We've got a bill up before The Lege to allow such programs and, of course, Gov. Perry just came out against it.  I'm not going to copy any of Vince's post because it's very short and I'd rather just direct you there--he's got an overview of what such programs accomplish and the misguided but very brief statement from Perry at Perry Doesn't Support Needle Exchange.  And it looks like Floor Pass got this particular story out first (though their post pre-dated the Perry statement), so I better give them props for that:  Needle Exchange Bill Poised to Pass Senate.

The Pope on Condoms: Dogma Trumps African Lives

En route to Africa, the Pope stirred up global controversy by minimizing the effect condom usage may have in stemming the spread of HIV/AIDS in Africa.  The science news aggregation site 80Beats looks at the story in During Africa Visit, Pope Knocks Condoms for HIV Prevention:

...during his flight to Cameroon the Pope told reporters that AIDS is “a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which can even increase the problem” [BBC]. Instead, the solution lies in a “spiritual and human awakening” and “friendship for those who suffer” [AFP].

I think that the response to this that made the most sense and fully expressed the disregard for the lives of millions of Africans in the Pope's statement was from the leader of a health campaign in South Africa in the story, Pope Claims Condoms Could Make African AIDS Worse Crisis:

Rebecca Hodes, of the Treatment Action Campaign in South Africa, said that if the Pope was serious about preventing new HIV infections he would focus on promoting wider access to condoms and spreading information about how best to use them.

Hodes, the director of policy, communication and research for the campaign group, added: "Instead, his opposition to condoms conveys that religious dogma is more important to him than the lives of Africans."

International Human Guinea Pigs

In The Constant Gardener, Ralph Fiennes plays a British foreign services type who gets embroiled in international intrigue involving clinical trials of a drug in Kenya after his wife (Rachel Weisz) is brutally murdered because of her investigations of the drug trials.  Some of the ethical concerns raised in that movie are front and center in a recent report in the New England Journal of Medicine.  The Corpus Callosum has a good discussion of some of the issues and the need to come up with answers to the questions involved in exporting drug trials to developing countries.  Check it out here, Clinical Research and Its Discontents:

Pharmaceutical and device companies have embraced globalization as a core component of their business models, especially in the realm of clinical trials. This phenomenon raises important questions about the economics and ethics of clinical research and the translation of trial results to clinical practice: Who benefits from the globalization of clinical trials? What is the potential for exploitation of research subjects? Are trial results accurate and valid, and can they be extrapolated to other settings? In this article, we discuss recent trends in and underlying reasons for the globalization of clinical research, highlight important scientific and ethical concerns, and propose steps for the harmonization of international clinical research.

The post has a link to the original NEJM report in its entirety, a bonus I don't often see with science articles.