Regulations

Disease outbreak guarantees: A proposal to build public health capacity in developing nations (rerun)

lborkowski — Wed, 28 Dec 2016 10:40:04 +0000

Disease outbreak guarantees: A proposal to build public health capacity in developing nations (rerun)

The Pump Handle is on a holiday break. The following, which was originally published on July 8, is one of our favorite posts from 2016.

by Kim Krisberg

In 2005, the World Health Assembly adopted a revised version of its International Health Regulations, a legally binding treaty among 196 nations to boost global health security and strengthen the world’s capacity to confront serious disease threats such as Ebola and SARS. A decade later, just one-third of countries have the ability to respond to a public health emergency. That’s why Rebecca Katz thinks it’s time to get creative.

“How can we think creatively about incentives for countries to build the required public health capacity under international treaty obligations,” Katz, an associate professor of international health at Georgetown University, told me. “What kind of arguments can be made to make public health infrastructure a core component of development programs?”

One way, she argues, could be through the World Bank Group’s Multilateral Investment Guarantee Agency (MIGA), which provides political risk insurance to help promote investments in developing countries. Basically, MIGA is a public insurance option for high-risk projects that can’t secure private insurance, essentially providing a pathway for direct foreign investment in developing nations. For example, Katz said, imagine a business wants to build a dam in a politically instable country, but no private insurer will take on the risk that the project could be derailed by civil war or expropriation. Instead, the investor could turn to MIGA to insure the project.

And so Katz’s idea is to link MIGA insurance and public health capacity — MIGA would only offer insurance in countries with a decent public health infrastructure in place or in countries making sufficient progress toward such an infrastructure. Katz, along with Richard Seifman, an international health consultant formerly with the World Bank, published their idea in June in the Journal of Health Care Finance, where they wrote:

Virtually all developing countries will need or want increased direct investment, but the intricate connection between high-risk infectious disease prevention, preparedness and external investment financing has not been on the public sector radar, global or otherwise. Countries and the international financing community must identify a means to allay the concerns of external investor(s) that may choose one developing country over another based on external disease threats. …

For example, a mining company may consider a new construction project requiring thousands of workers and in a country that has a weak health care and public health infrastructure, limited to nonexistent capacity to detect or respond to an infectious disease outbreak, and has a high endemic disease burden. The company’s business plan cannot afford an Ebola-like event, which would shut down its operation. The country, however, desperately needs the mining investment but is strapped for public funds to do what is needed to advance its infectious disease capacities and preparedness planning. If a MIGA guarantee premium formula over the life of the private investment could be based on rewarding a country making improvements, it would be a win-win situation.

In other words, Katz said, the new MIGA requirements could lead countries to focus on public health capacity, which would result in a country securing MIGA assurances, which could then lead to more private investment in countries that need such investments the most. The journal article suggests that MIGA’s “Breach of Contract” language could cover a government’s agreement to take “reasonable steps in meeting the (International Health Regulations) core capacities.” In theory, that agreement would be breached if the government failed to build or make progress toward building such public health capacity.

The article lists a brief step-by-step approach to putting the MIGA idea into action, including a three-to-five year pilot phase.

“It’s about making public health and health care a core component of a country’s priorities,” Katz said.

Of course, the countries in question are very often resource-poor and face a number of competing and often urgent priorities. Many just don’t have the resources to build an adequate public health infrastructure, Katz said, and changing the MIGA standards won’t make those resources automatically appear. But she said the cost of building such public health capacity would “almost surely” be passed on to investors and built into project negotiations between countries and private business.

“The entire global health security agenda was built around the idea that we needed a different way to think about funding countries to build (public health) capacity,” Katz told me. “This is just one idea, but these are conversations that have to be had.”

And Katz and Seifman offer a handful of compelling examples about why such conversations are so important, highlighting the severe impacts of recent global disease outbreaks. According to the article, cumulative losses in Guinea, Sierra Leone and Liberia associated with the Ebola outbreak totaled more than $2 billion as of mid-2015; the 2003 SARS outbreak cost Canada and Southeast Asian nations about $50 billion; and Middle East Respiratory Syndrome in South Korea resulted in more than 17,000 people being quarantined and about a 40 percent drop in foreign visitors.

“Given the World Bank’s existing efforts to protect against pandemics, MIGA should be part of the Bank’s suite of activities to provide for a more comprehensive approach to prevent, prepare and react to public health emergencies,” the article states. “No viable private sector insurance options exist in this space, nor is there any private/public mechanism alternative on the horizon.”

But should we be concerned about attaching critical public health capacity in developing nations to private investment? Shouldn’t such public health efforts be well funded regardless? Of course, said Katz, but it’s just not happening to the extent it needs to be.

“I understand that perspective, but we’re talking about parts of the world that desperately need that foreign investment,” she told me. “We have to be pragmatic…we have to think about the whole of society and if (public health) just stays in its own lane then we’re not being creative. There’s just not enough money in our lane to do the type of work we need to get the job done. I wish there was.”

Katz said she and her colleagues have received some good feedback on the MIGA idea from officials at the World Bank. But, at this point, she just wants to “put the idea out there.”

“It’s about getting new ideas out there and getting our community to think of all the different ways we can get the resources we need,” Katz said. “We’re trying to spark a conversation.

For a full copy of Katz and Seifman’s article, visit the Journal of Health Care Finance.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

lborkowski Wed, 12/28/2016 - 05:40

Tags

government

infectious diseases

Public Health - General

Developing Countries

Disappointing summer for progress by OSHA on new worker safety regulations

cmonforton — Fri, 29 Aug 2014 13:29:23 +0000

Disappointing summer for progress by OSHA on new worker safety regulations

Just before Memorial Day---the kickoff of the summer season---the Obama Administration released its agenda for upcoming regulatory action. In the worker safety world of OSHA, “regulatory action” rarely means a new regulation. Rather, it refers to a step along the long, drawn-out process to (maybe) a new rule to protect workers from occupational injuries, illnesses or deaths.

The items identified by the Labor Department suggested that OSHA planned a productive summer of 2014. Here’s what OSHA outlined for its summer tasks.

In May 2014:

Convene a meeting of small business representatives to review a draft proposed regulation to better protect workers employed in healthcare, correctional facilities, homeless shelters and other settings from infectious diseases.

Accomplished? NO

In June 2014:

Publish a request for information from stakeholders to address the hazards faced by those who work on communication towers, in particular the risk of working at heights.

Accomplished? NO

In July 2014:

Publish a proposed rule to protect workers who are exposed to beryllium, which can cause lung cancer and chronic beryllium disease. More than two years ago, in February 2012, the world’s largest producer and supplier of beryllium AND the United Steelworkers handed OSHA the regulatory text of a proposed rule on beryllium. It was a document that the two key stakeholders had thoughtfully negotiated. They expected their effort would expedite OSHA's work on a rule.

Accomplished? NO

In August 2014:

Publish a final rule to address confined space hazards for construction workers. In 1993, OSHA issued a confined space standard but it did not cover construction workers. The agency proposed a regulation in 2007 that would apply to the construction industry and the public comment stage of the rulemaking concluded in October 2008.

Accomplished? NO

Convene a meeting of small business representatives to review a draft proposed regulation to address the hazard of workers being struck when construction vehicles and other equipment are operating in reverse (backing up.) OSHA notes that in 2011, 75 workers were fatally injured in backing incidents.

Accomplished? NO

Publish a proposed regulation that would clarify employers’ obligation under an existing regulation to make and maintain accurate records of work-related injuries and illnesses.

Accomplished? NO

Publish a request for information from stakeholders to better protect shipyard workers from fall hazards and make existing regulations consistent with industry consensus standards.

Accomplished? NO

It's hard for me to believe that OSHA was unable to accomplish a single one of these seven tasks. I have to wonder whether something else is going on. For all I know, the agency has completed its work on some of them and tied them up with a nice red bow, but higher ups in the Obama Administration have put the brakes on them. It wouldn't be the first time the Administration has shown its aversion to new OSHA regulations. In 2010, OSHA proposed a change to the form on which just a fraction of employers are required to record work-related injuries and illnesses. The only modification was that employers would have been required to place a check mark—-a check mark—in a column on the form to distinguish musculoskeletal disorders from other injuries, such as burns or amputations. After completing the public comment period and extra stakeholder meetings, OSHA submitted the final rule for review to the White House's Office of Information and Regulatory Affairs (OIRA). It sat there for six months and then the Administration ~~forced OSHA to ditch~~ withdraw the rule. Then there was OSHA's proposed rule on silica which was "under review" at OIRA for 2 1/2 years.

Whatever is going on---whether performance problems at OSHA or anti-regulatory obstruction higher up in the Obama Administration---OSHA set expectations of what it would accomplish over the summer months. Now Labor Day is upon us and it was a disappointing summer for progress by OSHA on new worker safety regulations.

cmonforton Fri, 08/29/2014 - 09:29

Tags

cell tower safety

government

healthcare

Occupational Health & Safety

Study finds high support for public health interventions, few worries about encroaching 'nanny state'

lborkowski — Mon, 18 Mar 2013 09:55:06 +0000

Study finds high support for public health interventions, few worries about encroaching 'nanny state'

by Kim Krisberg

When it comes to public health law, it seems the least coercive path may also be the one of least resistance.

In a new study published this month in Health Affairs, researchers found that the public does, indeed, support legal interventions aimed at curbing noncommunicable diseases such as diabetes, heart disease and obesity. However, they're more likely to support interventions that create the conditions that help people make the healthy choice on their own. They're less likely to back laws and regulations perceived as infringing on individual liberties. It's a delicate balance, but encouraging news for public health workers.

"Public health should feel emboldened by this study," said co-author Michelle Mello, director of the Program in Law and Public Health at the Harvard School of Public Health. "There is public support for the enterprise they've embarked on...the question is how to do it in a way that capitalizes on (that support)."

Mello and her co-author Stephanie Morain examined public perceptions of what they called the "new frontier" in public health law — legal interventions focused on human behavior to prevent noncommunicable disease. Such "new frontier" interventions include reducing trans fat consumption, increasing cigarette taxes or implementing school-based efforts to identify overweight or obese children. The study notes that in 2000, the nation's three leading causes of death were tobacco use, poor diet and physical inactivity, and alcohol consumption. More than 75 percent of U.S. health care costs are related to preventable chronic conditions. Mello and Morain write:

The controversy calls into question the public’s willingness to view as legitimate uses of the power of the state any new-frontier interventions that attempt to use the law to prevent noncommunicable disease by influencing personal health behavior. Securing and maintaining legitimacy — that is, the public belief that officials have moral and legal authority to address the problem of noncommunicable disease and its behavioral underpinnings — is critically important because that authority affects people’s willingness to support and comply with public policies. Compliance with such interventions, in turn, is a critical determinant of the extent to which the policies will achieve their objectives.

"We were really interested in the novel efforts by public health departments to make new entrees into the chronic disease realm," Mello told me. "This isn't a totally new realm (for public health), but there is a new emphasis."

In surveying more than 1,800 U.S. adults, the two researchers found high support for government action on "new frontier" public health efforts. For example, more than 80 percent of respondents supported government action to prevent cancer, heart disease, childhood obesity and to help people control their diabetes. An even higher proportion of respondents said the government had a responsibility to address more traditional public health issues, such as providing vaccines and preventing food-borne illness. Respondents also had positive opinions of public health agencies, especially the Centers for Disease Control and Prevention and state and local health officials.

A particularly interesting, but probably not surprising, finding was dramatically lower levels of support for measures believed to be individually coercive. For example, policies to make fresh fruits and vegetables more affordable or to post calorie counts received supports of 83.6 percent and 80.8 percent, respectively. But support for an insurance premium surcharge for obese individuals only received the support of 37.6 percent of respondents. Similarly, more than 72 percent of respondents supported providing people with free nicotine patches; only 20 percent supported allowing employers to test and fire employees for tobacco use.

"These findings suggest that continuing the current focus on using law to shape health environments, instead of exerting more direct pressure on individual behavior, is a sound strategy for maximizing the legitimacy of policies," the study authors wrote.

Engaging the public in public health

Mello told me she was surprised at the high levels of support almost all the interventions received, noting the constant warnings of encroaching nanny states and over-reaching government that tend to dominate the media. In contrast, "our study revealed a quiet majority that supports the aims of these types of interventions...actually they want the government to do more," she said. She said she also thought that those people targeted by the interventions would be less likely to support them. But, with the exception of smokers, that wasn't the case. People who were overweight or living with diabetes tended to welcome public health interventions.

"In terms of political feasibility...we saw a gradient in public support that matched the gradient in coercion," said Mello, who is also a professor of law and public health in Harvard's Department of Health Policy and Management. "As a political matter, the smoothest path is to pick interventions that aren't choice restricting, that don't infringe on personal liberties. The dilemma, however, is that those (interventions) might not be the most effective."

Both Mello and Morain said engaging the public in the policymaking process could be key to public buy-in and compliance. Their study noted that the "strongest predictor among the belief measures we tested was the perception that 'people like me' can influence government priorities in public health." Morain, a doctoral candidate in the ethics tracks of the Interfaculty Initiative in Health Policy at Harvard, told me that support levels ticked up when people believed the government understood their values.

"It's really important to involve the public in priority-setting activities, to understand the values held by different populations and to be able to communicate how their values are being reflected in the policymaking process," Morain said.

Scott Burris, director of the Public Health Law Research Program at Temple University, said the Health Affairs study is among those "exploding the myth that people don't like public health interventions." Referencing his own body of work, Burris said that in the last 50 years, there's been few public health developments more important, more effective or more popular than the use of law to intervene on behaviors and environments to make people safer. For instance, he cited laws restricting tobacco use and making motor vehicles safer — "today, nobody would say we shouldn't have laws against drunk driving or promoting seat belts," he said.

"What's happening now is we're moving toward deeper causes ... how health is built into our society," Burris told me. "We're not talking about someone crashing into a wall and being saved by an airbag — there's that strong link between intervention and harm. ...We don't have the epidemiology yet that has convinced people that buying a Big Gulp soda is the same as smoking a cigarette."

The food and beverage industries are formidable — as was witnessed this week when a judge struck down New York City's law restricting certain establishments from selling sugary drinks larger than 16 ounces (the ruling will go to appeal this summer) — but they're not unbeatable, Burris noted.

"If you take the long view and look at our public health successes and how they've bubbled up from all over the place...you see that we continue to have a pretty good record of beating the big money," he said.

Luckily, people are beginning to realize that serious problems such as obesity and diabetes aren't simply related to a person's individual choice. It's also the physical, organizational and social environments that shape our behaviors — "now, people are saying, 'hold on, this isn't just natural, it's a logical consequence of the way we organize our communities and our society,'" said Alex Wagenaar, associate director of the Public Health Law Research Program and a professor of health outcomes and policy at the University of Florida. Wagenaar said it's entirely conceivable that in a couple of decades, laws targeting obesity and diabetes will be as commonplace and accepted as the public health laws and regulations we take for granted today. (For example, he noted that it was a big fight to get car manufacturers to install seat belts and yet today buckling up is the norm.)

"It's hard at the start, but it seems like we have no other choice," Wagenaar told me. "We have to take on these issues...and use policies to shape the environment in a more healthy way."

Mello noted that an interesting solution is to use "nudge interventions" in which choices aren't restricted, but the choice environment is altered. For example, in a cafeteria, make the healthy food choices the first choices people see. In other words, use what we know about human decision-making tendencies to the advantage of better health, she said.

"I think we'll see gradual changes over time," Mello said "This all very new and it may take a generation for people to appreciate the magnitude of these health threats and to really accept concrete interventions."

To read more about the Health Affairs study, click here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

lborkowski Mon, 03/18/2013 - 05:55

Mitt Romney's idea of freedom: businesses free to do whatever they darn well please?

cmonforton — Tue, 17 Apr 2012 07:00:00 +0000

Mitt Romney's idea of freedom: businesses free to do whatever they darn well please?

Mr. Mitt Romney spoke this weekend at the National Rifle Association's (NRA) annual convention and kicked off his remarks applauding the gun-lovers group's defense of the 2nd amendment to the Constitution. "This fine organization is sometimes called a single-issue group," Romney said. "That's high praise when the single issue is freedom.

I love my freedom as much as the next person, but I sure don't believe that background checks on individuals purchasing guns and appropriate waiting periods are a gross assault on individual liberty. We in public health consider violence a preventable cause of injury and death, and in the U.S. gun violence is epidemic in some communities. In recent years, firearm homicide for U.S. youth aged 10-19 was the second leading cause of death, and firearm suicide for the same age group was the fifth leading cause of injury death.

I'm skeptical of politicians and pundits who extol in speeches the virtues of the free enterprise system but fail to acknowledge the abuses that can come along with it. Because a true free-market system only exists in text books, regulations are needed to compensate for its malfunctions. Mr. Romney conveniently forgets that fact.

His speech went on like this:

"...This President is moving us away from our Founders' vision. Instead of limited government, he is leading us toward limited freedom and limited opportunity. ...The American economy is fueled by freedom. Free people and their free enterprises are what drive our economic vitality. ...Under President Obama, bureaucrats are insinuating themselves into every corner of our economy, undermining economic freedom. They prevent drilling rigs from going to work in the Gulf. They keep coal from being mined. They impede the reliable supply of natural gas. They tell farmers what their children can and can't do to help on the farm."

No drilling in the Gulf? No coal being mined? No children toiling on their parents' farms? I'll let PolitiFact and others tackle those untruths and exaggerations (here, here, here, here, here.) Mr. Romney went on:

"...If we continue along this path, we'll spend our lives filling out forms, complying with excessive regulations and pleading with political appointees for waivers, subsidies and permission. That path erodes freedom. ....Instead of expanding the government, I will shrink it. Instead of raising taxes, I will cut them. Instead of adding regulations, I will scale them back. The answer for a weak economy is not more government. It is more freedom!"

Mr. Romney is short on details, but in his free enterprise vision may mean that businesses could be free to do whatever they darn well please. The heck with those pesky regulations to protect public health and safety.

Away with rules requiring coal mine operators to check regularly for explosive methane gas;

Away with rules requiring refineries from spewing toxics into the air;

Away with rules requiring construction companies from securing 300-ton cranes;

Away with rules requiring healthcare workers from wearing radiation badges;

Away with rules requiring demolition companies from removing asbestos in a self-contained environment;

Away with rules requiring guards on machinery, brakes on equipment, and railings around elevated walkways;

Away with rules requiring manufacturers from providing workers information on the chemicals to which they are exposed;

Away with rules requiring water utilities from disinfecting the water piped to our homes;

Away with rules preventing children from working in coal mines;

Away with rules limiting the hours of work for airline pilots;

Away with rules requiring farmers from providing drinking water and toilets to farm workers.

Mr. Romney must think that many of us long for the days when our waterways wreaked with industrial waste, our autos exploded on impact, and we'd watch Walter Cronkite reporting on a coal mine explosions or construction project disasters. I sure don't.

His latest stump speech is just another example of the Republican front-runner being incredibly out of touch.

cmonforton Tue, 04/17/2012 - 03:00

Tags

Occupational Health & Safety

"Mr. Romney is short on details"
I thought this was going to be his campaign slogan...

One could go to a system with no regulations but a mandatory payout of say $12,000,000 for each death and less amounts for injuries (no fault the employeer would pay). Reading some books on the history of the rail road industry, as costs mounted up safety campaigns took place. According to leaders count one of the big causes of accidents was leaping on and off moving trains, so it was made a fireing offense to do so.
I picked $12,000,000 as it is twice the number typically used in cost benefit analysis as the cost of a life.
Make the number high enough and the employeer makes workplace safety a concern due to the hit to the pocketbook.

The truth about health, safety and environmental regulations

cmonforton — Wed, 31 Aug 2011 13:00:00 +0000

The truth about health, safety and environmental regulations

In a week that House Majority Leader Eric Cantor (R-VA) rallied his Members with a plan to repeal "job-destroying regulations," the Center for Progressive Reform (CPR) provides strong evidence to debunk the House Republican's rhetoric. In "Saving Lives, Preserving the Environment, Growing the Economy: The Truth about Regulation," CPR scholars provide concrete examples of profound benefits to society of safety and environmental regulations. It's a stark contrast to Mr. Cantor's one-sided view of regulations: they cost money, while completely ignoring their value to the health, safety and security of our country.

The Republican leader takes particular aim at several proposed Environmental Protection Agency (EPA) rules on ozone, particulate matter, and emissions from industrial boilers and incinerators. He argues they are too costly without saying a word about the thousands of lives saved, healthcare costs avoided, sick days averted, IQ points preserved, etc., etc., annually if these protections were put in place. That's the exact misleading strategy that the CPR scholars take aim:

"Regulatory opponents resort to this scare tactic becasue they cannot demonstrate that the country is illed serve by government regulation."

Where Mr. Cantor gives a one-side (estimated cost only) description of alleged "job-killing regulations," the CPR report offers loads of examples with multiple impacts. They cite, for example:

a study from the Economic Policy Institute that found the major EPA rules issued in the "first two years of the Obama Administration produced total annualized benefits of between $44 billion and $148 billion, as compared to total annualized costs of between $6.7 billion and $12.5 billion," and

a "look-back" review of OSHA's grain handling standard that reported a 70 percent reduction in fatalities from explosions, and 44 percent reduction in suffocations, while sales and profits increased, no substantial change in the number of firms, and no subtantial change in employment.

The examples in CPR's report go on-and-on. The authors correctly note that

"public opinion polling tells us that many Americans are suspicious of government regulation in the abstract, a reaction on which regulatory opponents seek to capitalize."

But, we also know that when Americans are asked about specific regulations, like USDA rules to ensure meat isn't contaminated, or EPA rules to prevent contaminated discharge from sewage treatment plants, they think those rules are important to protect their families' health and safety.

The CPR report also contains an appendix summarizing the key findings of the 38 "look back" reviews prepared on EPA and OSHA regulations, as required by Section 610 of the Regulatory Flexibility Act. I noted in particular the significant number of times the worker safety regulations spurred innovation and increased productivity.

For all the podium thumping about job-killing regulations, the CPR authors remind us of the consequences of failed or inadequate regulations. Based on information supplied by employers to the U.S. Bureau of Labor Statistics, since 2007, about 1.5 million workers per year have lost their jobs due to extended mass layoffs. On average, the employers only attributed 0.3 percent of the job losses to government regulations.

"This pales in comparison to any accounting of the jobs lost in this period due to the regulatory failures that contributed to the economy's financial crisis."

cmonforton Wed, 08/31/2011 - 09:00

Tags

Environmental health

Environmental Protection Agency

Occupational Health & Safety

Open science, openly arrived at

revere — Fri, 07 May 2010 04:20:58 +0000

Open science, openly arrived at

As an academic researcher I don't write grant proposals for a living, although sometimes it feels like I do. I need grants to do my work, but I also need to get to work and I don't consider myself to be commuting for a living. Although sometimes it feels like I do. Having said that, low on my list of favorite things would be anything that required even more compliance paperwork for a grant proposal, but the National Science Foundation (NSF) is now about to spell out a new compliance paperwork requirement, and frankly I approve of it. In principle, at least, although I won't like doing it if it spreads to my own granting agencies. NIH already has something like it and it needs to do more, even if I'll hate doing it.

We are talking about something euphemistically called a "Data Management Plan." It's really an open data access initiative for products paid for by the taxpayer and it's overdue:

Scientists seeking funding from the National Science Foundation (NSF) will soon need to spell out how they plan to manage the data they hope to collect. It's part of a broader move by NSF and other federal agencies to emphasize the importance of community access to data.
[snip]

NSF wants to avoid a one-size-fits-all approach to the issue, [Edward Seidel, acting head of NSF's mathematics and physical sciences directorate] explained, because each discipline has its own culture about data-sharing. "A scientist might say that my plan is that I don't need one, because I don't save my data," he told the board committee, which has just formed a task force on data policy. "The important thing is that it puts people on notice that they have to think about it, maybe for the first time." NSF Director Arden Bement said he expects that some applicants will request additional funding to implement their data management plan, making it another factor that reviewers will need to take into account in weighing the value of a proposal. (Jeffrey Mervis, ScienceInsider)

Sounds good, although it doesn't sound specific enough or tough enough to me. Yes, each discipline does have its own culture about data-sharing. And in many cases that culture has to change. We've inveighed often here about the shameful practice that many senior and well-respected flu scientists have of keeping their sequences private until they publish -- if they publish using them. If not, no one gets to see them, even if we paid with tax money to collect them. The motives are often unselfish -- a senior scientist trying to protect post-docs or grad students from being scooped. Very Old School. This is the 21st century. We have our own students and we take mentoring very seriously. And one of the things we teach them is that if they have information of importance to public health, then it is to be made public. You don't make any deals with anyone that you will keep it confidential. Period. And you don't keep hold of it on your own initiative, either. Influenza virus sequences are matters of public health importance. If you are worried your career or the career of your students or post docs will be harmed by releasing them as soon as practicable, then you are in the wrong field. Choose a field or a virus where it doesn't matter. But keeping those sequences private is part of the "culture of the discipline." And it needs to change.

As an epidemiologist it can take me years of hard work to collect data. I want to use that data and reap its benefits, both for public health and for me personally and my students and post docs. That doesn't mean I get to hoard them. It means that I have to use them in a timely way. I have an advantage over everyone else because I know the data better than they do and I have it before they do. But I don't have any ownership rights over it. If someone else can use my work, that's what science is all about. Making it available and accessible should be part of the culture of my discipline. It isn't, sad to say. But what should also be part of the culture is that if I use someone else's data (or vice versa), data made accessible to me by virtue of a granting agency's policies, I should give full credit to those who collected it and that credit should count in terms of academic appointments and promotions.

I know there is genuine resistance and resentment about this among my colleagues. I think it's a losing battle for them, however, and I hope they lose it sooner rather than later. Science will be better off. The internet allows public access to an unprecedented degree, and the amount of "raw brain power" out there is quite incredible. It is not inconceivable to me that access to data could allow some amateur scientist or very smart lay person to make an important scientific discovery.

Open science, openly arrived at. That's the culture I'm talking about.

revere Fri, 05/07/2010 - 00:20

Tags

Academia

Intellectual Property

"it doesn't sound specific enough or tough enough to me".
I suspect it's hard to make rules valid for every discipline. There should be different rules for different panels.
For example, I'm a mathematician. I don't have any data. I'm not doing experiments, ever.
On the other hand, I know that a lot of more-or-less ready material in my field circulates informally before its arxiv release, sometimes for 6+months, or even years. This gives an unfair advantage to the "friends of" who get to see said material before the rest of the community. Maybe a rule that says "you can't keep your papers hidden" would seem as weird to you as your preoccupation with data is to me.

estraven: You are right, of course, that there are differences. My son is a mathematician and I hang out in math departments quite a bit. The LANL preprint arXiv really blazed the trail for the rest of us, but it is pretty generally available if you know about it. And it happened because it took you guys so long to referee papers. And mathematicians used to be terrible about keeping their stuff secret (think Tartaglia and friends, not to mention Newton). Times change and the post was about changing times.

Security theater: are they satisfied now?

revere — Tue, 27 Apr 2010 04:09:14 +0000

Security theater: are they satisfied now?

Once, long ago, I used to be in a radiology department in a famous hospital. I liked radiology quite a bit and even before becoming a doctor I worked in them. Later I did research on the kinds of errors radiologists make when they read x-rays. One of the errors that was extremely well known even 40 plus years ago (although that didn't prevent it from being made with dismaying consistency up to and including today) was something called "satisfaction of search error." In essence, it meant that once one abnormality was found on an x-ray, there was an increased chance of missing a second, unrelated one.

Radiologists have known about this for a long time, but apparently people in other fields haven't. It's not just medicine. It is plausible to think that any task involving searching through a constantly changing and complex cognitive field might also have this problem. Like screening luggage at the airport. According to a paper in press at the Journal of Experimental Psychology: Applied by Fleck, Samei and Mitroff, this is exactly what we can expect:

This new study examined whether that concept also applies to airport-security scans, and it seems that it does. In fact, the researchers found, the problem may be worse among luggage screeners because they are under more time pressure than radiologists. They write that scrutinizing luggage for toothpaste and hair gel may come "potentially at the expense of finding additional targets which may be better concealed and less frequent, such as scissors, box cutters, or pocketknives."
The study was conducted using Duke University students and computer simulations. So it's reasonable to ask whether trained airport-security personnel would fall victim to the satisfaction-of-search issue. But, according to the authors, previous research suggests that, no matter how much training you have, the problem persists.

Obviously there are valid reasons for being concerned about potential weapons disguised as everyday items. But there may be a cost to being too careful. (Tom Bartlett, Percolator Blog at The Chronicle for Higher Ed)

The hair gel/liquids restriction was stupid from day one, a typical case of Bruce Schneier's "Security Theater." It's been obvious that much Security Theater hurts us by being costly, inconvenient and ineffective. Now it appears it can also make us less secure.

What will they think of next? NB: that's not a rhetorical question.

revere Tue, 04/27/2010 - 00:09

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Heh. This coincides with my anecdotal evidence ... When I showed up too late for a flight a couple of years back to check my bags, I dragged the one I had intended to check (which was just a little bit too big for a carryon) over to security. They not only missed the size issue (which the annoyed flight attendant thought they should have caught, according to what she said after I boarded), but about half a dozen items that were clearly outside the security guidelines, including a large nail file. They did catch my canister of shaving gel. "You can't bring this on the plane," the TSA screener told me, frowning. "Oh, OK--just throw it away, then," I responded, waiting to hear the rest of the list of things I couldn't take. Nope--that was it. They'd caught the forbidden gel, so their job was done, evidently ... I decided not to try to hijack the aircraft with my nail file, toenail clippers, or shampoo.

It's a shame that basic science like this will probably be ignored in favour of throwing more regulations at the problem.

This happened to me when I brought the wrong bag to the airport. The shampoo was taken, the penknife and the conditioner weren't found.

I've used the same principle to hide an empty magnetic keyholder in an obvious position, while the one with the key was much better hidden.

Regarding forbidden items: my wife had to throw out an unopened single-serving container of yoghurt. I've no idea how this could be used as a weapon. It is probably more an indication that 50% of all people, including security personnel, are of below average intelligence.

Revere- thank you for highlighting this study. Not only do we have diminishing marginal returns of the newer security regulations due to the low positive predictive value of screening all shoes and liquids/gels/aerosols, we are detecting these "threats" at the possible expense of real threats.

RGS- I suspect you are too harsh on the security personnel. This is a systems problem, not a marker for individual intelligence. If TSA makes a rule that no liquids/gels/aerosols of greater than 3 oz can be carried on a plane, then security personnel have to carry out that rule.

It's like working with a moving company. I've heard friends tell of companies that shipped trash cans full of food waste for a cross-country move. It sounds stupid- why not just throw the garbage out? But professional movers have to work within the financial and legal realities of their trade: (a) The secret to packing really fast is to not think. If you stop to think about every item, you're going to waste time deciding whether it's trash or whether the owner really wants it, and time lost = money lost. (b) If you throw out what looks like garbage (even when it obviously is, like the Hefty bag of food scraps), then one day you're going to have an owner say they had dropped their jewelry in the trash by mistake and now you are liable for the cost of the reported jewelry. Safer just to pack everything, and leave the owner to throw out their own garbage before you show up.

Of course it's all theatre. The object is to keep the flying unwashed frightened, timid, docile, and obedient.

The rest of the flying public is never bothered by the TSA. If you're a corporate honcho, nobody searches you or your luggage, and there is no waiting at the airport: the corporate jet waits for you, its engines warming up when the pilots are notified by your driver that your limousine has reached the airport.

Sure, corporate jets would make excellent flying suicide bombs, but this is a risk we have to take -- because important people cannot be troubled. Abuse is only for the underclass.

@If you're a corporate honcho, nobody searches you or your luggage, and there is no waiting at the airport: the corporate jet waits for you, its engines warming up when the pilots are notified by your driver that your limousine has reached the airport.

Hmm. My corporation's honchos flew economy in 2008. Cost cutting measures.

Rose Colored Glasses. You are right.

Roman. So because your companies corporate honchos fly economy, you point exactly is what? Do you deny the existence of corporate jets used by corporate executives just because your corporation does not have one.

I don't say they should be subject to security checks, but the Bin Laden family for example may have a corporate jet in Saudi Arabia, if not I doubt they fly commercial when they come to the US, probably hire a charter, so... Not saying they are a threat even if OBL is, but you know....

In the meantime the peasants will have to fly naked soon.

Theater.

Security theatre struck me last year when heading over to New Zealand for some trout fishing and family holiday. My carry on had a small box of trout flies, size 12 nymphs to be exact, that I was told were a danger because they had sharp points, and would have to be confiscated before boarding.
The image of me taking over the plane with a deadly 10mm fish hook struck my funnybone and I burst out laughing. Unfortunately the "security officer" thought I was laughing at him, and things went a bit pear shaped for awhile until they relented, and put the deadly weapons in a sealed pouch to be guarded by the flight crew until we landed.
If you saw it in a movie, you wouldn't believe it.

Food that makes you sick: not much progress

revere — Sat, 17 Apr 2010 04:24:01 +0000

Food that makes you sick: not much progress

It would be surprising if failure to fund local public health and neutering regulation would result in a decrease in foodborne illness. Alas, there is nothing surprising about CDC's latest report on incidence of foodborne illness in the US. They put the best face on it they could, pointing to a decrease in E. coli O157H7 cases, but they've seen that kind of progress in E. coli before only to slip back.

In reality we aren't sure how much food poisoning occurs each year. Most of it is self-limited and never comes to the attention of medical or public health authorities. It never gets counted. More serious cases may or not be recognized as foodborne. CDC has a Foodborne Diseases Active Surveillance Network (FoodNet) within its Emerging Infections Program which conducts active surveillance in 10 states, counting lab confirmed cases for specific intestinal agents often transmitted via food. Foodnet provides an estimate for the incidence ("risk") of lab confirmed foodborne illness per capita for various enteric pathogens going back to 1996:

FoodNet surveillance data for 2009 show reductions in the incidence of STEC O157 [E. coli] and Shigella infections, but little or no recent progress for other pathogens. Of the four infections with Healthy People 2010 targets (Campylobacter, Listeria, Salmonella, and STEC O157), only the target for STEC O157 was met in 2009 [but also briefly met in 2004]. Salmonella infections declined slightly in 2009. A modest increase in the incidence of Listeria infection is a concern; however, the incidence of Listeria infection continues to be substantially lower than at the start of FoodNet surveillance in 1996. Continued increase in the incidence of Vibrio infection points to a need for improved prevention measures. Shigella is often transmitted directly from person-to-person, so food safety measures might not relate to the decrease in shigellosis.
To optimally prevent foodborne illness, the routes of exposure to these pathogens must be understood better so that additional targeted control measures can be developed, even as U.S. food consumption patterns and food industry processes evolve. FoodNet studies have demonstrated associations between illness and consumption of foods such as undercooked ground beef, chicken, and eggs. Recent outbreak investigations have identified novel food and nonfood vehicles, including jalapeno peppers, peanut butter--containing products, raw cookie dough, and direct contact with baby chicks, turtles, and African dwarf frogs (CDC, Morbidity and Mortality Weekly Reports).

Using Foodnet data things seem to have gotten better since counting began in 1996, but this is still a guess since most of foodborne illness goes uncounted in ways that are probably only crudely reflected in lab confirmed data. Real progress will depend on adequate regulation and enforcement of interstate food producers and food and restaurant inspection by local public health. While we might expect some progress at the federal level, state and local agencies are so squeezed by the bad economy and inadequate support that I doubt things will improve much. They might even deteriorate.

The only saving grace is that without being able to count it or recognize it, we'll never know how bad it it is.

revere Sat, 04/17/2010 - 00:24

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Revere,

Although this surveillance is conducted under a foodborne disease program, don't forget that many of these pathogens (STEC, Shigella, Campylobacter, Salmonella, Cryptosporidium, etc.) may also be waterborne.

As our national public drinking water infrastructure continues to degrade, and municipal water treatment systems are squeezed by a combination of degrading water quality and lack of funding, we may find that a larger proportion of these infections are ultimately attributable to contaminated drinking water.

Farmer: You are correct. That's why I was careful to say in the post "specific intestinal agents often transmitted via food."

An article headlined at the bottom of the food quality news article you linked points to a story about a Produce Safety Project report by Robert Scharff estimating the overall cost of foodborne illness at a staggering $152 Billion per year. To get there, he includes the cost of "pain and suffering", which I find problematic. Even without that padding, he comes up with over $100B a year. The link in the article to the whole report is broken, but the Pew Trust has it here: http://www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/Reports/Produce_…

No fly disease regs don't fly

revere — Sat, 03 Apr 2010 04:53:58 +0000

No fly disease regs don't fly

Better late than never. When the Bush administration proposed sweeping airport quarantine rules in 2005, even those of us most concerned about avian influenza thought it was a fruitless policy on scientific grounds, not to mention issues of civili liberties and economics. The airlines hated it, too:

The regulations, proposed in 2005 during the Bush administration amid fears of avian flu, would have given the federal government additional powers to detain sick airline passengers and those exposed to certain diseases. They also would have expanded requirements for airlines to report ill passengers to the CDC and mandated that airlines collect and maintain contact information for fliers in case they later needed to be traced as part of an investigation into an outbreak.
Airline and civil liberties groups, which had opposed the rules, praised their withdrawal.

The Air Transport Association had decried them as imposing "unprecedented" regulations on airlines at costs they couldn't afford. "We think that the CDC was right to withdraw the proposed rule," association spokeswoman Elizabeth Merida said Thursday.

The American Civil Liberties Union had objected to potential passenger privacy rights violations and the proposal's "provisional quarantine" rule. That rule would have allowed the CDC to detain people involuntarily for three business days if the agency believed they had certain diseases: pandemic flu, infectious tuberculosis, plague, cholera, SARS, smallpox, yellow fever, diphtheria or viral hemorrhagic fevers such as Ebola. (Alison Young, USA TODAY)

It isn't that pandemics don't happen. We just had one. Or that air travel doesn't spread disease. The 2009 pandemic spread so fast largely because of air travel. Ironically it was the 2009 pandemic that did the proposed rules in because it was obvious they would have done nothing to stop the spread. They just wouldn't work. Indeed even for the poster child for this kind of measure, the flying TB lawyer, it didn't work -- nor was any harm done to anyone because of the failure.

This was the kind of "public health theater" typical of administrations that have no other solutions. The Bush administration was famous for this but the Obama White House had a similar response around the Christmas underpants bomber episode. Now we'll be virtually strip searched at the airport by scanner, likely to no avail. They'll find nothing that way but some other simple workaround by a terrorist wannabe will reveal a new security hole. The galling thing is that people in these administrations know this, too. Even in the Bush White House there was controversy we now learn:

Even in the Bush administration, some were skeptical of the CDC's 2005 proposal, said Stewart Baker, assistant secretary for policy at the Department of Homeland Security from 2005 to 2009. "There were a lot of questions about how plausible it was to treat airports as a place where you could stop and inspect and quarantine people," Baker said Thursday.

Now he tells us? Makes me ant to take off my shoes and whack him over the head with them.

revere Sat, 04/03/2010 - 00:53

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CDC

Pandemic preparedness

Public health preparedness

regulation

Regulations

Identifying sick people is not that easy. Some time ago while commenting at another blog I looked up some statistics about using thermal scanners to identify people with elevated temperatures at airports. This was done to see if such methods could be used to slow the spread of flu. Such scanning was implemented at an airport in Canada and one in China (I think). I don't remember the exact numbers, but basically of many thousands of scanned people, not one actual case of flu was identified, although a number of people were pulled aside for positive readings.

Mark: This has been a topic here, too. See here, here, here.

There were components to the proposed regulations that didn't make any sense, but as someone who is tasked with tracking down passengers possibly exposed to communicable diseases on aircraft, I can tell you that it's not an easy thing to do (and exposures happen more than people might think). Contact information is often unavailable or incorrect.

The workaround to contact information is having every passenger fill out a health questionare like they did in Asia dueing the SARS outbreak. Providing false information is punishable by law.

But really, you can be just as easily infected on a bus, train, baseball game, or movie theater. These proposals are all about giving government more control over peoples freedoms. Get them used to being treated like cattle on planes, and you can do the same anywhere.

I suspect that the faster spread of new viruses via travel before they become too deadly helps spread herd immunity and is thus preventing a repeat of a 1918 event. Quarantines may be counterproductive in that case.

Indeed contact tracing is a Herculean undertaking. Several papers throughout the years suggest it costs way more than just treating the illness as--or if--it occurs. We have to modernize our approach to infectious disease exposures of public health significance. Mitigating is better than containment . Now only if we could convince individual states to drop the nonsense of enhancing quarantine policies. 14 century measures in the 21st century just don't work.

BTW Revere, I love my iPad so don't delay running out and getting one-waiting for vacation is too long to be without.

Salmonella, food safety and potato chips

revere — Fri, 12 Mar 2010 05:12:22 +0000

Salmonella, food safety and potato chips

When last we visited the US food safety system during the Bush administration it was busy serving up peanut butter with a side of Salmonella. That one caused over 4 thousand product recalls, 700 Salmonella cases and at least 9 deaths. Now it's Salmonella serovar Tennessee in hydrolyzed vegetable protein (HVP), a common flavor enhancer used in all sorts of food products, including, according to the FDA, soups, sauces, chilis, stews, hot dogs, gravies, seasoned snack foods, dips and dressings. An important difference -- so far -- is that there are no illnesses traced to the contaminated ingredient. Progress, I guess. But in other respects the stories sound pretty similar:

Federal inspectors concluded that a food company that produced hydrolyzed vegetable protein (HVP) at the center of a series of food recalls continued to ship its products after it learned of Salmonella contamination in its processing facility, the FDA said yesterday.
The FDA said the company, Basic Food Flavors Inc., Las Vegas, continued to distribute its HVP paste and powder until Feb 15, despite the fact that its private lab found Salmonella in environmental samples collected at the plant on three different occasions, twice in January and once in early February.

The FDA said its inspection also exposed several problems with the company's building and its manufacturing procedures.

In a statement accompanying its inspection report, the FDA said the firm filed a report through the FDA's new Reportable Food Registry after one of its customers found Salmonella in the company's HVP, prompting an FDA investigation that began on Feb 12 and found Salmonella Tennessee on processing equipment. After discussions with the FDA, the company on Feb 26 announced that it was recalling all HVP it had produced since Sep 17.

According to the inspection report, called form 483, on Feb 19 the company's private lab reported finding Salmonella in a finished lot of product. (Lisa Schnirring, CIDRAP News)

But as Kevin Allen [an assistant professor of food microbiology at the University of British Columbia] observed over at Barfblog, it isn't just the supplier that has a responsibility. Food producers, especially very big ones, also have a responsibility to test the ingredients they put into their product. Instead, to cut costs, they are more and more relying on a "certificate of analysis" from the vendor (here Basic Food Flavors, Inc.) that the ingredient was microbiologically safe. Both this case and the Peanut Corporation of America case show why such certificates should be reasonably relied upon. Time to start testing again.

Meanwhile we see what can happen to a big food producer like Proctor & Gamble, makers of Pringle's. In keeping with a recommendation by the FDA, P&G is voluntarily recalling two flavors of their potato crisps, Pringles Restaurant Cravers Cheeseburger and Pringles Family Faves Taco Night potato crisps. But why should I tell you about this when there is a more authoritative source:

The Colbert Report

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Consumer Alert - Pringles

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revere Fri, 03/12/2010 - 00:12

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"The FDA said the company, Basic Food Flavors Inc., Las Vegas, continued to distribute its HVP paste and powder until Feb 15, despite the fact that its private lab found Salmonella in environmental samples collected at the plant on three different occasions, twice in January and once in early February."
I hope the FDA prosecutes Basic Food Flavors Inc to the full extent the law allows; the fact they put profit before the health of millions is utterly inexcusable.

Dear Revere,

Interesting post. I was not aware that S. Tennessee was a serovar of significant public health importance. Is this an unusual event or has this serovar been associated with cases of human disease?

There are however a few points that I feel need some more clarification or fine tuning. The fact that the company kept producing product in spite of positive environmental samples is not particularly unusual or, indeed, too risky. Environmental contamination of food processing facilities is common on a day to day basis and does not mean necessarily that a significant contamination will occur on the finished product. It usually means that cleaning protocols need to be looked at. In fact any particular microbiological test should not be looked at with excessive attention because microbiology in general is quite poor at giving garantee of product safety. Food pathogens tend to be distributed in an extremelly un homogeneous way through the environment and product and random sampling (especially if we are simply sampling at level required by legislative requirements are wholly insuficient as a snap shot indicator of what is happening at a particular moment. They can only be usefull on a long term as trend indicators of underlying problems occurring.

To me what is really worth of criticism is the trend, which comes from many years which started in the states and has now spread through Europe, as I was saying the trend of de-regulation of the food safety sector, that companies will "self-regulate" that HACCP is some sort of Graal that will magically resolve hygiene problems and that therefore, legislation can adopt a "light touch2 approach and be less prescriptive in the requirements it imposes to the industry.

Reality is: HACCP is on it's conception and basis a voluntary system, success depends completelly on management in a particular factory being willing in adopting it. It is pure stupidity to force implementation through legislation. You can place market incentives for people to adopt it, but for the operators who work in the margins of the law, that are not sensible to these issues only prescriptive measures will force them to adopt a minimum set of hygiene procedures and only if they are under the constant surveillance of a regulating authority. The only reason why they set refrigetrators to 7 Celsius or 4 or even have them in tefirst place is because the law prescribes such measures of care.

In this context increased microbiological sampling should be adopted in principle but I do wonder if this should be a first priority. Microbiological sampling is incredibly innefective at assessing the safety of a particular batch of food.