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Aetiology

Discussing causes, origins, evolution, and implications of disease and other phenomena.

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Tara C. Smith is an Assistant Professor of Epidemiology. Her research involves a number of pathogens at the animal-human nexus. Additionally, she is the founder of Iowa Citizens for Science and also writes for The Panda's Thumb and previously for WIRED SCIENCE's Correlations. Please note the views expressed on this site are Dr. Smith's alone and may not be representative of the groups mentioned above.

"...a veritable expert on tawdry cosmetic procedures gone horribly awry..."--Kevin Beck

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Infectious Disease Series

June 1, 2009

Silence is the enemy

Category: ActivismPoliticsPublic health

"I always think someone is following me and wants to rape me. It is better to die." --Darfuri refugee

Sometimes there comes a public health issue that's so big, so overwhelming, so heinous, that you just don't know where to begin discussing it. Nevertheless, the conversation should, and must, happen just the same. Silence may be easier, but speaking out is the only way to demystify the taboos and bring attention to what's going on for those who can't bring attention to it themselves. And maybe, just maybe, bring about some change.

It's no secret that rape happens during wartime. Certainly documents being discussed regarding our own soldiers' treatment of prisoners show that wartime rape--of either "the enemy" or even female colleagues--is not limited to rogue armies in far-off countries some Americans probably couldn't even find on a map. That doesn't make it any less inexcusable, or the crimes any less horrendous, just because we've done it, too.

A recent piece in the New York Times by Nick Kristof highlighted the extent of these rapes even after the war has stopped, discussing rape in Liberia. As Kristof notes, the war in Liberia ended officially in 2003 after 14 years. However, even today--6 years into peacetime--a high percentage of the female population reports a history of rape, including girls as young as 3 years old. Of 275 sexual violence cases treated in just four months' time in Liberia by Doctors without Borders, 28% involved children age 4 or younger, and a third involved children ages 5-12. Children are easy targets, and the most powerless of all possible victims.

Of course, rape is older than civilization itself, just like the view that women are second-class citizens (if we count as citizens at all). You may have heard about these types of rapes--of women, of children, by solo men or gangs; using only their bodies or using whatever object is handy, including guns or knives, to rape their victims--being carried out in Darfur, in the Congo, or elsewhere. Celebrities have written about it in excruciating detail, documenting some of the horrors: a child held and raped for 2 weeks, left alive but incontinent, humiliated, and shamed. 6-month-old infants raped. 80-year-old women raped and brutalized. 1,100 women raped every month in Eastern Congo according to United Nation estimates.

The situation in Darfur probably has received more international attention than other countries, yet still, little has been done--and the future of what *can* be done is uncertain, as many foreign aid groups were kicked out in March.

For those who have fled the brutality in Darfur, the situation remains bleak. A new report was just released documenting the issues Darfuri women face in refugee camps, including repeated rapes and a lack of any legal recourse either in their home country or in the camps. They are imprisoned--unable to help themselves by even getting firewood or tending to animals because of the potential for rape at the periphery of the camps--and have no one to turn to. Indeed, in many areas, the perpetrators carrying out these crimes are the very ones who are supposed to be protecting women--police, military and government officials, even teachers. In Liberia, despite having the first female president of an African country, little progress has been made in changing laws or attitudes about rape, and the country still lacks an adequate legal system able to adequately prosecute the small percentage of rapes that are reported.

What to do about this? That's what's kept me from writing more about this, I suppose--the sheer magnitude of what is happening, and the helplessness one feels when reading about it. With infectious diseases, though some of them are equally overwhelming, at least there is the hope of prevention via relatively simple devices (bed nets for malaria; condoms for HIV; isolation and medical treatment of TB, and of course the hope for vaccines, etc.) With systematic rape, there is no drug or vaccination to look for in the future. What is needed instead are shifts in attitude: more respect toward women; societal intolerance of such crimes by men; empowerment of women and girls; an understanding by family members of those who were raped; cessation of femicide. These are overwhelmingly difficult things to ask for, especially in countries fragmented by years of war and violence. How does one help to accomplish these things in far-off countries, when it's hard enough to be respected as a woman right here in the U.S.?

A recent editorial by the editors of PLoS Medicine provides some places to start:

Medical professionals are powerful lobbyists whose recognition of the devastation could galvanize support for the work of humanitarian organizations and advocacy groups in documenting sexual atrocities and holding states accountable when human rights and international law are violated. Together with medical journalists and editors they have done much to try to expose the devastation of sexual violence during conflict, but we can all do more to document and disseminate the research and accounts of health workers, nongovernmental organizations, and survivors.

And they're right. No, gang rape isn't exactly great fodder for cocktail parties. It's incredibly uncomfortable and depressing to speak about--and that's probably one reason it's gone on as long as it has, with relatively little attention. It's taboo to discuss--not only in countries like Liberia or Sudan, but here in the US as well. It needs to stop, and we can help make that happen. Talk to someone about this. If you can't do it in person, write a letter. Write your congressperson. Hell, write your mayor. Highlight it on your own blog. See if a local women's group--or any other group interested in global health or women's rights--has covered the issue recently, and if not, offer them any of the linked articles to spark the conversation. Email your local newspapers or TV stations. Send a mass email to your friends--this is certainly more important and worthy of their attention than the latest viral YouTube video, right?

Finally, keep checking back. This month frees up a bit of time for me, so I'll highlight some of the other posts on this topic around the blogosphere as I see them crop up, in order to keep the discussion going and look for other ways to help and other perspectives on the issues. I'll also write on some related topics. Additionally, keep an eye on Sheril and Isis's blogs for more posts and updates. Along with them (and potentially others, which I'll mention as I see them), I'll be donating any wages from the blog this month to Doctors Without Borders as a token of appreciation for the work they've done for the victims of these brutal crimes. I'll have a list of other charities you may want to consider in a future post.

Silence is the enemy. Speak out. Pass it on.

[Edited to add: Sheril has a list of participating blogs here, including NY Times author Nick Kristof with his post highlighting the movement. We now have a Facebook page for "Silence is the Enemy" here; and you can search Twitter using #silencehurts.]

May 5, 2009

Bill Maher on swine flu and evolution

Category: Infectious diseaseIntelligent design/creationism

Now if he could just get his science straight when it comes to vaccination...but perhaps this mean he's changed his views on the germ theory?

(H/T Louis)

May 4, 2009

Misc. links

Category: General EpidemiologyInfectious diseaseInfluenzaOutbreakPublic healthScience educationVarious viruses

Back to the grind this week unfortunately, but the swine flu/H1N1 story is still developing and still fascinating. The most recent numbers show 286 confirmed US cases in 36 states.

There are many remaining questions on the evolution and epidemiology of this strain--and many pundits sure they know what's going to happen next. Mike takes one of them down--Wendy Orent, who I've blogged about previously. Orent is claiming (based on a black/white version of the evolution of virulence in pathogens) that the spread of this strain is attenuating the virus, and that future outbreaks will be milder. Mike nicely explains why that may, or may not, happen--and why it's folly to predict with certainty either scenario at this point.

Unrelated to influenza, an editor at the Guardian is angry at anti-vaxers, after his young daughter (11 months old, too young for the MMR vaccine) has developed measles:

According to the Health ­Protection Agency there were 1,348 cases of ­measles last year, compared with 56 in 1998. In 2006 a 14-year-old boy died of ­measles - the first fatal case for 14 years. The reduction in herd immunity is ­causing unnecessary suffering.

The decision by many of my neighbours not to vaccinate their children is on a par with the drunk who decides to get into his car to drive home. It is a personally reckless action that also endangers the lives of everyone else on the road. Society should view the MMR refuseniks with the same degree of scorn.

Finally, the winners of the 2009 Alliance for Science Essay contest have been announced (H/T Panda's Thumb and Evil Monkey).

May 3, 2009

Why are the schools closing and other good H1N1 links...

Category: General EpidemiologyGeneral biologyInfectious diseaseInfluenzaOutbreakPublic healthVarious viruses

Over at DailyKos, DemfromCT has an excellent post explaining why it may be beneficial for schools to close temporarily, even if they only have one confirmed case of swine influenza: H1N1: Why Do Schools Close, And When Do They Open?

DarkSyde also has one up on the basic biology and evolution of the flu.

Nick Kristof discusses our lack of attention to public health and what it means in the event of a pandemic in today's NY Times.

[Updated: and via the comment theads, this post which further discusses what I mentioned here regarding testing--and how the confirmed cases are only the tip of the iceberg (complete with diagram!).

May 1, 2009

Adamantane resistance in flu explained

Category: General biologyInfluenzaVarious viruses

Nick Anthis has a very nice (and very readable!) overview of why flu viruses (including the new A/H1N1 strain) are resistant to adamantane, one of the antiviral drugs that can be used to treat influenza infections.

April 30, 2009

What does the WHO's pandemic scale mean? And why is anyone worried about this?

Category: General EpidemiologyInfectious diseaseInfluenzaOutbreakPolicyPublic healthVarious viruses

I've been seeing a lot of comments mocking the current outbreak of H1N1, and a lot of people (and journalists) who don't understand what "big deal" is about the "snoutbreak" of swine influenza, or don't get what the raising of the World Health Organization's pandemic alert phase up to 5 means. I noted here what the alert level meant, but wanted to discuss it a bit more in a full post; after the jump.

April 29, 2009

Iowa investigating two "probable" swine flu cases

Category: Infectious diseaseInfluenzaIowa/area newsPublic healthVarious viruses

It was only a matter of time:

Iowa Gov. Chet Culver says the state has two probable causes of swine flu.

Speaking Wednesday at a Statehouse news conference, Culver told reporters that officials would know Thursday if the cases are swine flu.

Officials say one case was from a California resident who visited Scott and Clinton counties last week. The other was a woman who returned from Mexico and traveled through Johnson, Des Moines and Muscatine counties.

State Medical Director Patricia Quinlisk says both of the people infected were now recovering.

Should know by tomorrow if they are confirmed or not.

Wired: H1N1 a hybrid of 2 pig isolates

Category: Infectious diseaseInfluenzaOutbreakPublic healthVarious viruses

Brandon Keim at WiredScience has a new article on swine flu genomics.

"This is what we call a reassortment between two currently circulating pig flu viruses," said Andrew Rambaut, a University of Edinburgh viral geneticist. "Why it's emerged in humans is anyone's guess. It hasn't been seen before in pigs as far as I know."

***

"The new neuraminidase gene that came in from Eurasian swine is one we've never before seen circulating in humans," said Rambaut. "That's one of the reasons it's spreading rapidly. Very few people will have any immunity to this particular combination, which is what gives the concern that this will be a pandemic rather than just a normal seasonal flu outbreak. It remains to be seen how much and to what extent there is existing immunity."

Story still evolving...Keim does mention that "a document released to scientists and obtained by Wired.com affirms their analysis." Could be out in the literature soon, possibly?

I was hoping to have a post up today with more thoughts on the whole pig issue, but no time to do anything but quick posts. Hopefully tomorrow...

US up to 91 cases, including 1 death [Updated: New England confirmed cases]

Category: Infectious diseaseInfluenzaOutbreakPublic healthVarious viruses

The latest numbers of confirmed cases from the CDC were released about an hour ago. 91 cases have been confirmed, with the largest numbers in New York (51), California (14), and Texas (16). One new case has also been confirmed in Nevada, one in Indiana, one in Arizona, and 2 in Michigan; the other Ohio case I know of is still pending, apparently. Ongoing investigations are also taking place in multiple states, so expect the number to keep rising for the time being. [Update: 2 cases just confirmed in Massachussets, and three in Maine.]

The first fatality has also been reported: a 23-month-old child who had recently traveled to Mexico traveled to the United States from Mexico.

I've written previously about how difficult research in infectious disease can sometimes be, knowing that many of the isolates you're working with harmed or even killed someone, and changed someone's life forever. This child's influenza virus will now be marked with a lengthy name based on the date and location of isolation, and will be studied and dissected on a molecular level, and referred to in dry publications discussing the case--but that doesn't mean that those who carry out the research and write up the manuscripts in such clinical language are any less touched and upset when deaths like this occur.

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