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“Ebola Politics”: Let Obama — And Frieden — Do Their Jobs

If the prospect of hanging concentrates the mind, then even the possibility of infection with Ebola should do the same — for all of us. Instead we seem easily distracted by attempts to blame President Obama and scapegoat the Centers for Disease Control and Prevention. Republican politicians and media loudmouths demand the resignation of Dr. Thomas Frieden, the CDC director, evidently because he refused to endorse a West African travel ban.

They’re all dead wrong.

First, Obama is following precisely the correct approach in addressing the outbreak with his order to dispatch American troops to Liberia. At this stage, no force except the U.S. military is capable of getting the situation in West Africa under control. The men and women of the medical corps can swiftly set up emergency tented facilities in every Liberian county, while security personnel begin to restore order and prevent panicked destruction.

The president didn’t foresee this outbreak, but neither did anyone else, principally because every earlier Ebola outbreak had been contained within a few rural villages. While his order to send troops isn’t popular – and nobody likes the idea of sending our troops into danger – he made a difficult but wise choice. (Our British and French allies have agreed to do the same in Sierra Leone and Guinea, respectively.)

Why are the unique characteristics and large scale of the U.S. military so vital now? Simply because no other force can adequately handle the logistical and safety requirements of this chaotic, perilous undertaking. To take just one example: Both our troops and the local health care workers will need an enormous supply of protective gear known as Personal Protective Equipment – each of which must be not just discarded, but carefully destroyed after a single use.

More broadly, the effort to contain Ebola needs very well-trained, well-organized, and well-disciplined people on the ground – which is to say, an army. Our military personnel are the best in the world, and will be able to provide leadership and guidance to the Liberians, organizing local health workers to restore order amid chaos and fear.

No organization except the U.S. military possesses the capacity to deal with such problems.

Second, the calls for Dr. Frieden to resign by Republican members of Congress more resemble cheap midterm campaigning than intelligent policymaking. Although the CDC has not functioned perfectly in the current crisis, its director is certainly the most qualified and experienced figure to stem a threatened outbreak of infectious disease. His expertise is not merely on paper, either.

During four of the worst years of the HIV/AIDS crisis in New York, when multi-drug resistant tuberculosis was taking a terrible toll, Dr. Frieden oversaw the program that eventually controlled TB and reduced cases by 80 pecent. For five years he worked in India, dispatched by the CDC to work with the World Health Organization to control TB in that country – where his efforts helped to provide treatment for at least 10 million patients and saved as many as 3 million lives. Those are among the reasons that President Obama appointed him in the first place – and why he still deserves far more confidence than the partisan screamers in Congress and on cable television now attacking him.

Now is the wrong time for politicians and pundits to harass the Pentagon and the CDC, as they address the difficult task at hand — which will require many weeks of intensive struggle. There will be plenty of opportunity for recriminations later, if that still seems necessary.

In the immediate aftermath of 9/11, when the country faced what felt like an existential crisis, many public figures, especially Republicans, urged everyone to put national unity and cooperation ahead of partisan bickering. It would be good if, just this once, they would follow their own advice.

What we will need in the months to come is a fresh assessment of our foreign aid programs. We need to understand why our traditional stinginess does both our country and our children a terrible disservice. Our best hope for survival, in the long term, is to notice how small our world has become – and to recognize that protecting our fellow human beings everywhere is the only way to protect ourselves.

 

By: Joe Conason, Editor in Chief, The National Memo, October 17, 2014

October 19, 2014 Posted by | Ebola, Politics, Republicans | , , , , , , , | Leave a comment

“Hyping The Threat”: Fear And Anxiety Are Bigger Threats Than Ebola

During the summer, I got hooked on a TNT drama called The Last Ship, an apocalyptic thriller about a global pandemic that wipes out most of the human population. As it happens, the telltale signs of this killer plague bear a striking resemblance to the symptoms of the Ebola virus.

Indeed, Hollywood has been inspired by Ebola for decades, almost since the virus was first identified in 1976. But in those fictional crises, including that portrayed in the 1995 film Outbreak, starring Dustin Hoffman, the virus has changed — either through mutation or human intervention — to become airborne, like smallpox and tuberculosis. If you are a screenwriter, you need that element of quick and easy contamination to sustain edge-of-your-seat suspense.

Characters in The Last Ship, for example, enter unfamiliar territory fully clad in protective gear for fear of suddenly sharing space with an infected person. They dare not breathe the same air if they expect to survive.

Real-world Ebola, however, isn’t that easy to catch, according to experts at the Centers for Disease Control and Prevention. It has caused a devastating pandemic in West Africa, where the medical infrastructure is poor to non-existent, but it won’t come close to that here, they say.

Still, judging from the news media, lots of my professional colleagues have seen Last Ship and Outbreak. They’re in full panic mode, hyping the threat and speculating about the possibility of a global pandemic that swamps the Western world as it has West Africa. That hysteria has only increased since Thomas Eric Duncan died last week in a Dallas hospital, becoming the first Ebola fatality in the United States.

As Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University, told The New York Times, “… at the moment, we have a much larger outbreak of anxiety than we have of Ebola.”

That’s partly due to the madness of partisan politics, where critics of President Obama look for any reason, rational or not, to blast him. Fox Not-News has had a steady stream of commentators blaming the president for Ebola patients in the United States, as if he’s the mad scientist of a Hollywood thriller.

But the 24-hour news cycle also demands hysteria, whether from liberal commentators or conservatives. Fear is one of the most powerful of human emotions, and it drives eyeballs to the TV screen and clicks online. If there is no genuine crisis, a manufactured one will have to do.

It’s also true, psychologists point out, that human beings have difficulty assessing risks. Many Americans, they note, have a fear of flying and would rather drive a long distance because they believe it’s less dangerous to do so. But numbers show that commercial aviation is much safer than doing battle with your fellow road warriors.

In 2012, the last year for which statistics were available, 33,561 people died in motor vehicles in the United States. The number killed in commercial airline accidents that same year? Zero.

If humans better understood risk, we’d focus more on the refusal of some Americans to have their children vaccinated against highly contagious childhood diseases. There is little risk from inoculations, but a grave risk in allowing an illness such as measles or whooping cough to get out of control.

Meanwhile, Ebola is indeed wreaking havoc. Just ask Sama King, a naturalized U.S. citizen who was born in Sierra Leone, one of the countries that have been hardest hit. After 30 years in her adopted country, much of that in Atlanta, she was thinking of returning to the place of her birth. But she has had to put that off to become an activist and fundraiser instead.

“We are grateful for what the international community has done, but it needs to do more. If (international agencies) had intervened earlier, we wouldn’t be where we are now,” she said.

King has worked to increase awareness of the pandemic and to raise money for food and protective gear. She is now focusing on the many orphans left behind in Sierra Leone, children who have nowhere to go, whose relatives may be afraid to keep them because of the stigma associated with Ebola.

Now that’s a genuine crisis.

 

By: Cynthia Tucker, Visiting Professor at the University of Georgia; The National Memo, October 11, 2014

October 15, 2014 Posted by | Ebola, Infectious Diseases, Public Health | , , , , , | Leave a comment

“The Right’s Scary Ebola Lesson”: How Anti-Government Mania Is Harming America

If not for serial budget cuts to the National Institutes of Health, we would probably have an Ebola vaccine and we would certainly have better treatment, NIH director Dr. Francis Collins tells the Huffington Post’s Sam Stein. This comes on the heels of reporting that the Centers for Disease Control’s prevention budget has been cut by half since 2006, and new revelations about how botched protocols at the Dallas hospital that turned away Thomas Eric Duncan and then failed to treat him effectively also led to the infection of one of Duncan’s caregivers.

Yet most of the media coverage of the politics of Ebola to date has centered on whether President Obama has adequately and/or honestly dealt with the disease. “I remain concerned that we don’t see sufficient seriousness on the part of the federal government about protecting the American public,” Texas Sen. Ted Cruz told reporters. Cruz is probably the wrong guy to talk about seriousness: his government shutdown forced the NIH to delay clinical trials and made the CDC cut back on disease outbreak detection programs this time last year.

I find myself wondering: When, if ever, will the political debate over Ebola center on the way the right-wing libertarian approach to government has made us less safe?

My fans at Newsbusters and other right-wing sites were outraged last week when I raised questions about whether Texas Gov. Rick Perry shared some responsibility for the nation’s Ebola crisis with President Obama, since the outbreak occurred in his state on his watch. Now that a second person has been infected there, I think the question is even more relevant.

The GOP approach to public health was crystallized at the 2012 debate where Rep. Ron Paul – another Texas politician — said it wasn’t the government’s responsibility to take care of a hypothetical young man who showed up in the emergency room very sick after he decided not to buy insurance. “That’s what freedom is all about, taking your own risks,” Paul said, deriding “this whole idea that you have to prepare to take care of everybody …”

“Are you saying that society should just let him die?” moderator Wolf Blitzer asked. And the crowd roared “Yeah!” (For his part Paul answered no, but said hospitals should treat such cases as charity and not be compelled to do so.) Lest you think either Paul or that Florida audience represented a minority sentiment in the GOP, recall that none of his rivals, not even Mitt Romneycare, challenged Paul’s approach at the debate.

But now we know what happens when hospitals fail to adequately care for uninsured people who turn up in the ER: They can die, which is awful, but they may also spread disease and death to many other people. It’s pragmatism, not socialism, that commits governments to a public health agenda.

That agenda, however, has been disowned by the modern GOP. Sarah Kliff got lots of attention for her Vox piece starkly depicting how the Centers for Disease Control’s prevention budget has been cut by more than half since 2006. The chart she used actually came from a piece in Scientific American last week, which I hadn’t seen before. It’s must-reading: it dispassionately explained the way we’ve underfunded and degraded our public health infrastructure. And again, it made me think about the Republican policies that have hampered our ability to fight this crisis.

Isn’t there a fair way to say that cutting 45,700 public health workers at the state and local level, largely under GOP governors, was irresponsible? As was slashing the CDC’s prevention budget by half since 2006, or cutting the Affordable Care Act’s prevention budget by a billion? Sen. John McCain wants an “Ebola czar,” but the Senate is blocking confirmation of the Surgeon General. Isn’t it fair to ask whether the constant denigration of government, and the resulting defunding, now makes it harder to handle what everyone agrees are core government functions?

It seems relevant to me that Texas is 33rd in public health funding. It’s clear now that not just the hospital but state and local authorities responded inadequately to Duncan’s illness. His family and friends were quarantined, but left to fend for themselves; county public health officials didn’t even provide clean bedding. “The individuals, it’s up to them … to care for the household,” Erikka Neroes of Dallas County health and human services told the Guardian a week after Duncan had been admitted to the hospital. “Dallas County has not been involved in a disinfection process.”

When the disinfection process began, belatedly, there’s evidence that was botched as well. The Guardian found a team of contractors with no protective clothing simply power-washing the front porch, for instance, when it should have been scrubbed with bleach. A baby stroller sat nearby.

As the great science writer David Dobbs concluded last week: “So the richest country on earth has no team to contain the first appearance of one of the most deadly viruses we’ve ever known.”

I’ve found myself wondering if Ebola is unquestionably a plus for Republicans three weeks before the midterm, as everyone (including me) has assumed. Certainly Republicans think it is; that’s why vulnerable Senate candidates, from Thom Tillis in North Carolina to Scott Brown in New Hampshire, are fear-mongering about it.

But if Democrats are the party of government, and thus seen as culpable by voters when government does wrong, aren’t government-hating, budget-slashing Republicans politically vulnerable when we need government to do something right, and the cuts they’ve pushed have compromised its ability to do so?  Or does IOKIYAR mean the media just shrugs when the GOP fear-mongers, but would punish any Democrat respond in kind?

Blogger Kevin Drum likes to complain about a Democratic “Hack Gap” – the fact that liberal pundits are too willing to criticize Democratic leaders, while GOP pundits more often line up behind theirs. I don’t agree with Drum – in the end, Chris Matthews and I didn’t cost the president his re-election in 2012 – but it’s an interesting debate. Personally I think Democrats have a “Brilliant and Ruthless Campaign Operative Gap,” when it comes to shamelessly exploiting the other side’s political weakness.

The GOP’s anti-government crusade has hampered our ability to face the Ebola challenge. In an election year, there’s nothing wrong with Democrats saying that clearly. Campaigns should be cutting ads right now spotlighting the way Republican budget cuts have devastated the public health infrastructure we need to fight diseases like Ebola. Here’s one such ad from the Agenda Project.

 

By: Joan Walsh, Editor at Large, Salon, October 13, 2014

October 14, 2014 Posted by | Anti-Government, Ebola, Right Wing | , , , , , , , | Leave a comment

“Ebola Doesn’t Abide By Borders”: Ensuring Our Public Health System Is Adequately Funded And Allowed To Do Its Job Is Key

The U.S. should not implement travel restrictions on countries impacted by the Ebola crisis and here is why. The Ebola outbreak has reminded the world what public health officials have known for centuries: Infectious disease does not respect geographical borders.

There was a time when we travelled the globe in ships and across land. In those days travel took months and diseases died out or were easy to contain using quarantine measures and broad travel restrictions.

We now live in a global society during a time when the variables we are trying to compute are numerous and complex. The vast number of people traveling around the world, the speed of travel, the large number of conveyances and the presence of multiple ports of entry into our country argues for a focused, well-tested and science-based approach to reducing the risk of exposure to this highly lethal infectious disease.

I’ve just returned from South Africa with a connection through Amsterdam, Netherlands. While this is far from West Africa, I saw a system of health and customs officials on high alert looking for ill passengers, passenger screenings using temperature monitors at airports and health advisories in airports to inform passengers how to protect themselves. What I saw, in fact, was a responsive, competent public health approach at work.

Preventing travel from affected countries is an inadequate measure. Not only do we need to ensure rapid passage of people in and out of the area for response purposes, but we also need to ensure the continued flow of supplies desperately needed to address the outbreak at its source, which is the best way to break the chain of infection. With the number of people passing through airports all over the world, identifying those who could have come into contact with people from affected countries is an impossible task. Multiply this by the number of connecting flights through European or other international hubs and it becomes even harder.

While we are appropriately worried about Ebola, enterovirus-68 has sickened more than 628 people in 44 states and the District of Columbia, a severe coronavirus – the Middle East respiratory syndrome – is circulating in the Middle East and chikungunya virus has entered our country. We have many significant biological threats, and they are all managed best through proven public health measures.

I have yet to hear calls to quarantine our borders between states while these serious diseases are already here because such a measure, of course, would be ineffective. Sound disease surveillance, case finding, monitoring and treatment is the appropriate approach. Ebola, although highly lethal, can be managed using these proven methods. We know its epidemiology, its biology and how to defeat it.

A strong, well-developed and adequately funded public health system is the key to containing Ebola and all of these other infectious threats. Unfortunately, ongoing budget cuts to the Centers for Disease Control and Prevention and other health agencies continue to put a strain on resources. Policymakers who want to be part of the solution need only to support ensuring our public health system is adequately funded and allowed to do its job.

Yes, we should screen travelers, but restricting travel is not the solution. A focused, robust and science-based public health response is.

 

By: Georges Benjamin, M.D., Executive Director, American Public Health Association; Publisher, Control of Communicable Diseases Manuel; Debate Club, U. S. News and World Report, October 10, 2014

October 13, 2014 Posted by | Congress, Ebola, Public Health | , , , , , | Leave a comment

“Silencing The Science”: How The Gun Lobby Shut Down Gun Violence Research

On December 14, a 20-year-old Connecticut man shot and killed his mother in the home they shared. Then, armed with 3 of his mother’s guns, he shot his way into a nearby school, where he killed 6 additional adults and 20 first-grade children. Most of those who died were shot repeatedly at close range. Soon thereafter, the killer shot himself. This ended the carnage but greatly diminished the prospects that anyone will ever know why he chose to commit such horrible acts.

In body count, this incident in Newtown ranks second among US mass shootings. It follows recent mass shootings in a shopping mall in Oregon, a movie theater in Colorado, a Sikh temple in Wisconsin, and a business in Minnesota. These join a growing list of mass killings in such varied places as a high school, a college campus, a congressional constituent meeting, a day trader’s offices, and a military base. But because this time the killer’s target was an elementary school, and many of his victims were young children, this incident shook a nation some thought was inured to gun violence.

As shock and grief give way to anger, the urge to act is powerful. But beyond helping the survivors deal with their grief and consequences of this horror, what can the medical and public health community do? What actions can the nation take to prevent more such acts from happening, or at least limit their severity? More broadly, what can be done to reduce the number of US residents who die each year from firearms, currently more than 31 000 annually?1

The answers are undoubtedly complex and at this point, only partly known. For gun violence, particularly mass killings such as that in Newtown, to occur, intent and means must converge at a particular time and place. Decades of research have been devoted to understanding the factors that lead some people to commit violence against themselves or others. Substantially less has been done to understand how easy access to firearms mitigates or amplifies both the likelihood and consequences of these acts.

For example, background checks have an effect on inappropriate procurement of guns from licensed dealers, but private gun sales require no background check. Laws mandating a minimum age for gun ownership reduce gun fatalities, but firearms still pass easily from legal owners to juveniles and other legally proscribed individuals, such as felons or persons with mental illness. Because ready access to guns in the home increases, rather than reduces, a family’s risk of homicide in the home, safe storage of guns might save lives.2 Nevertheless, many gun owners, including gun-owning parents, still keep at least one firearm loaded and readily available for self-defense.3

The nation might be in a better position to act if medical and public health researchers had continued to study these issues as diligently as some of us did between 1985 and 1997. But in 1996, pro-gun members of Congress mounted an all-out effort to eliminate the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). Although they failed to defund the center, the House of Representatives removed $2.6 million from the CDC’s budget—precisely the amount the agency had spent on firearm injury research the previous year. Funding was restored in joint conference committee, but the money was earmarked for traumatic brain injury. The effect was sharply reduced support for firearm injury research.

To ensure that the CDC and its grantees got the message, the following language was added to the final appropriation: “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”4

Precisely what was or was not permitted under the clause was unclear. But no federal employee was willing to risk his or her career or the agency’s funding to find out. Extramural support for firearm injury prevention research quickly dried up. Even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence.

When other agencies funded high-quality research, similar action was taken. In 2009, Branas et al5 published the results of a case-control study that examined whether carrying a gun increases or decreases the risk of firearm assault. In contrast to earlier research, this particular study was funded by the National Institute on Alcohol Abuse and Alcoholism. Two years later, Congress extended the restrictive language it had previously applied to the CDC to all Department of Health and Human Services agencies, including the National Institutes of Health.6

These are not the only efforts to keep important health information from the public and patients. For example, in 1997, Cummings et al7 used state-level data from Washington to study the association between purchase of a handgun and the subsequent risk of homicide or suicide. Similar studies could not be conducted today because Washington State’s firearm registration files are no longer accessible.8

In 2011, Florida’s legislature passed and Governor Scott signed HB 155, which subjects the state’s health care practitioners to possible sanctions, including loss of license, if they discuss or record information about firearm safety that a medical board later determines was not “relevant” or was “unnecessarily harassing.” A US district judge has since issued a preliminary injunction to block enforcement of this law, but the matter is still in litigation. Similar bills have been proposed in 7 other states.

The US military is grappling with an increase in suicides within its ranks. Earlier this month, an article by 2 retired generals—a former chief and a vice chief of staff of the US Army— asked Congress to lift a little-noticed provision in the 2011 National Defense Authorization Act that prevents military commanders and noncommissioned officers from being able to talk to service members about their private weapons, even in cases in which a leader believes that a service member may be suicidal.9

Health researchers are ethically bound to conduct, analyze, and report studies as objectively as possible and communicate the findings in a transparent manner. Policy makers, health care practitioners, and the public have the final decision regarding whether they will accept, much less act on, those data. Criticizing research is fair game; suppressing research by targeting its sources of funding is not.

Efforts to place legal restrictions on what physicians and other health care practitioners can and cannot say to their patients crosses an even more important line. Yet this is precisely what Florida and some other states are seeking to do. Physicians may disagree on many issues, including the pros and cons of gun control, but are united in opposing government efforts to undermine the sanctity of the patient-physician relationship, as defined by the Hippocratic oath. While it is reasonable to acknowledge and accept the Supreme Court’s recent decision regarding the meaning of the Second Amendment, it is just as important to uphold physicians’ First Amendment rights.

Injury prevention research can have real and lasting effects. Over the last 20 years, the number of Americans dying in motor vehicle crashes has decreased by 31%.1 Deaths from fires and drowning have been reduced even more, by 38% and 52%, respectively.1 This progress was achieved without banning automobiles, swimming pools, or matches. Instead, it came from translating research findings into effective interventions.

Given the chance, could researchers achieve similar progress with firearm violence? It will not be possible to find out unless Congress rescinds its moratorium on firearm injury prevention research. Since Congress took this action in 1997, at least 427 000 people have died of gunshot wounds in the United States, including more than 165 000 who were victims of homicide.1 To put these numbers in context, during the same time period, 4586 Americans lost their lives in combat in Iraq and Afghanistan.10

The United States has long relied on public health science to improve the safety, health, and lives of its citizens. Perhaps the same straightforward, problem-solving approach that worked well in other circumstances can help the nation meet the challenge of firearm violence. Otherwise, the heartache that the nation and perhaps the world is feeling over the senseless gun violence in Newtown will likely be repeated, again and again.

 

By: Arthur L. Kellerman, MD, MPH and Frederick P. Rivara, MD, MPH, The Journal of The American Medical Association, December 21, 2012

December 30, 2012 Posted by | Gun Violence, Guns | , , , , , , , | Leave a comment

   

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