Recent reports indicate that community-acquired methicillin-resistant Staphylococcus aureus (MRSA... more Recent reports indicate that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing and may now involve persons without risk factors predisposing for acquisition. To estimate the extent of community MRSA in New York City, the prevalence of S. aureus and MRSA nasal colonization in a well-patient population of 500 children and guardians was determined. The prevalence of S. aureus nasal carriage was 35% for children and 28% for guardians. One person with predisposing risk factors was colonized with an MRSA, which was identified as the predominant clone found in New York City hospitals. A high degree of methicillin-susceptible S. aureus strain diversity was noted, with no apparent selection for specific clonal types. Thus, MRSA colonization is not ubiquitous in persons without predisposing risk outside of the health care environment. Bacterial competition and a lack of strong selection may limit the community spread of MRSA and can account for its sporadic distribution.
The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease manag... more The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease management, but also highlights the nature of contemporary public health: an endeavour primarily geared toward protecting the current political economy of the developed world and promoting middle-class moral propriety. Understanding how today's flu response is shaped requires insight into the history of germ theory; the development of new ways of thinking about the role of immunisation in the public sector; the public health industry's turning away from earlier concerns with social structure, poverty, discrimination, and access to resources; and, the development of a focus on individual behaviour. Close inspection of two important events in immunisation history-the creation of the polio vaccine in the 1950s and the American swine-flu fiasco of 1976-yields new awareness of the contemporary collusion between public officials and wealthy corporations, and helps to reveal how public health serves existing power structures. Introduction Almost everyone has taken some interest in epidemics of late. The noisy response to the epidemic of 2009, the H1N1 swine flu, made sure of that. Society certainly made too much of swine flu (many have blamed the media for that) (Brownstein 2009). Although some found people too complacent, or gratingly uncooperative with flu-control programs (Chan 2009; Shuchat 2009; Butler-Jones 2009), others thought too little attention was being paid to epidemics that seemed more important, like autism, obesity, attention-deficit/hyperactivity disorder (ADHD), or the auto-immune deficiency virus, AIDS (McKay 2009). The debate crystallised around campaigns to immunise whole populations against H1N1 flu. That the swine flu outbreak was comparatively mild relative to outbreaks of common, seasonal flu intensified the attention (according to the World Health Organisation there were 12,799 confirmed HlNl flu deaths worldwide as of the beginning of January 2010 (WHO 2010)). Even if this number is a two to six-fold undercount, as some would argue,1 there were still far fewer HlNl flu deaths in 2009 than the 250,000 to 500,000 per year normally attributed to seasonal flu (WHO 2003). That the outbreak was negligible relative to the calamitous loss of millions of lives predicted by health professionals and officials (PCAST 2009; Syal 2009) made for still sharper scrutiny of the response to the socalled pandemic. By late 2009, concerns were raised about conflicts of interest on the part of flu experts (Engdahl 2009). A resolution passed in December 2009 by the Assembly of the Council of Europe called for an enquiry into the influence of vaccine makers on the World Health Organisation's (WHO'S) flu policy, reflecting suspicions of arm-twisting or collusion (Silverman 2010). Accusations of hype came from both the democratic left (Chin 2009) and libertarian right (Daily Bell 2010); from vaccine supporters who feel that the overstatement of the swine-flu threat diminishes the public's faith in immunisation in general, and those who believe vaccines induce autism. What makes flu an epidemic? What makes any epidemic a threat? How much should the public be asked to sacrifice? How much money? How much liberty? In order to defend against the predicted catastrophe? Answering these questions requires delving into the history of vaccination. Germ Theory and the 1918-1919 Flu By the time the terrible influenza outbreak of 1918-19 had passed, the global toll was at least 20 million dead-although the true number of casualties is unknown, because so many died where disease surveillance was rudimentary, or simply died too suddenly to allow for official tallies (Johnson and Mueller 2002; Taubenberger and Morens 2006). The so-called Spanish Flu epidemic should have discredited the new germ theory, since its proponents were unable to do anything to ease the disaster (the influenza virus was not discovered until 1931). …
ESPITE THE INTRODUCTION OF the first antituberculin drugs almost 50 years ago, morbidity and mort... more ESPITE THE INTRODUCTION OF the first antituberculin drugs almost 50 years ago, morbidity and mortality associated with Mycobacterium tuberculosis remains a major public health threat. Recently, the study of tuberculosis (TB) epidemiology and transmission, traditionally accomplished by patient contact tracing, has been augmented by the use of molecular strain typing. A striking example was the identification of the W strain, a multidrug-resistant (MDR) clone that caused disease in more than 350 patients in New York City and accounted for more than 25% of all MDR cases in the United States in the early 1990s. 1-4 This MDR and successful clone, associated with high mortality rates in both New York prisons and hospitals, has since become the "index" strain in the Public Health Research Institute (PHRI) TB Center (New York, NY) and has been the focus of a number of molecular epidemiological studies. 1-6 It is generally accepted that M tuberculosis isolates with identical inser-Author Affiliations are listed at the end of this article.
Journal of acquired immune deficiency syndromes and human retrovirology, May 1, 1996
Cytomegalovirus (CMV) infection remains a life-threatening infection in patients with HIV disease... more Cytomegalovirus (CMV) infection remains a life-threatening infection in patients with HIV disease. A rapid, quantitative diagnostic technique is needed to adi in the diagnosis of CMV disease. This study was undertaken to evaluate the CMV antigenemia test in patients with HIV disease who are at risk for CMV disease. The study included 22 patients who underwent ophthalmologic exams or selected diagnostic techniques in whom CMV cultures and CMV antigenemia tests were performed. All of 11 patients with CMV disease had positive CMV antigenemia assays [range, 48-1,000 positive cells/2 x 10(5) peripheral blood leukocytes (PBL)], and 10 were also CMV viremic. There was no clinical evidence of CMV disease in 11 patients, including seven in whom the CMV antigenemia assay was negative and who remained without evidence of CMV disease after a median follow-up of 159 days. Four patients had low antigenemia levels. Of these four, two subsequently developed CMV retinitis. In conclusion, a positive CMV antigenemia result with > or = 48 positive cells/2 x 10(5) PBL correlated with concurrent CMV disease. The CMV antigenemia test appears to be a valuable tool for the rapid diagnosis of CMV disease in HIV-infected individuals.
Changes in the level of CD4-bearing T-lymphocytes in injection drug users infected with the human... more Changes in the level of CD4-bearing T-lymphocytes in injection drug users infected with the human immunodeficiency virus were evaluated in a sample of 318 subjects enrolled from a methadone program in the Bronx, New York, from 1985 through 1989. Follow-up continued through 1990. The percentage of CD4+ T-lymphocytes (CD4%) was used to maximize the stability of measurements. The rate of decline of the CD4% was determined using a random-effects assumption, and predictors of rate of decline were evaluated using an autoregressive model. The rate of CD4% decline was approximately 1.2 CD4% lost per 6 months, with a higher rate in recent seroconverters (2.2 CD4% lost). The most important predictors of decline of the CD4% in autoregressive models were current pyogenic bacterial infection (CD4% reduced by 2.75, 95% confidence interval (CI) 0.42-5.08), current report of a second constitutional symptom (CD4% reduced by 2.16, 95% CI 0.03-4.29), and history of bacterial infection (CD4% reduced by 1.49, 95% CI 0.09-2.89; proportion of prior CD4% lost increased by 0.14, 95% CI 0.01-0.27). Oral thrush was not related to an accelerated rate of CD4% decline.
Yale Journal of Health Policy Law and Ethics, 2013
Wide gaps in health status, access to health care, quality of care, and provision of health-relat... more Wide gaps in health status, access to health care, quality of care, and provision of health-related services are increasingly evident in the context of globalization. In the face of glaring disparities between the health status of the "Haves" and that of the "Have Nots," health professionals in wealthier countries must consider the impact of such disparities on the ethical conduct of health research. Unfortunately, currently established codes of moral conduct fail to provide adequate guidance for ethical decision-making in health research. Formal codes include the U.S. Department of Health and Human Services (DHHS) regulations for protection of human subjects, the Nuremberg Code, the Helsinki Declaration, and the guidelines of the Council for International Organizations of Medical Sciences Taken together, these documents constitute a body of important standards for protecting research subjects from harm and regulating the balance between potential risks to subjects and potential benefits. Yet, these standards fail to resolve ethical conflicts between upholding human rights and producing more information for medical benefit. Such conflicts are increasingly apparent as economic globalization reveals the depth of international disparities in resources and knowledge. In this Article, we examine how an ethics based on caring and responsibility can guide clinical research in a manner that is consistent with human rights and justice in the face of global disparities. We review two paradigms for moral reasoning-the morality of rights and the morality of care-with respect to applying the principles of human rights to health. The morality of rights relies on the abstract concept of justice to guide behavior. The morality of care, as the name suggests, seeks to guide decision-making in a way that takes care of others, examining real-world conflicts and contexts to resolve moral dilemmas. As such, it can
The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease manag... more The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease management, but also highlights the nature of contemporary public health: an endeavour primarily geared toward protecting the current political economy of the developed world and promoting middle-class moral propriety. Understanding how today's flu response is shaped requires insight into the history of germ theory; the development of new ways of thinking about the role of immunisation in the public sector; the public health industry's turning away from earlier concerns with social structure, poverty, discrimination, and access to resources; and, the development of a focus on individual behaviour. Close inspection of two important events in immunisation history-the creation of the polio vaccine in the 1950s and the American swine-flu fiasco of 1976-yields new awareness of the contemporary collusion between public officials and wealthy corporations, and helps to reveal how public health serves existing power structures. Introduction Almost everyone has taken some interest in epidemics of late. The noisy response to the epidemic of 2009, the H1N1 swine flu, made sure of that. Society certainly made too much of swine flu (many have blamed the media for that) (Brownstein 2009). Although some found people too complacent, or gratingly uncooperative with flu-control programs (Chan 2009; Shuchat 2009; Butler-Jones 2009), others thought too little attention was being paid to epidemics that seemed more important, like autism, obesity, attention-deficit/hyperactivity disorder (ADHD), or the auto-immune deficiency virus, AIDS (McKay 2009). The debate crystallised around campaigns to immunise whole populations against H1N1 flu. That the swine flu outbreak was comparatively mild relative to outbreaks of common, seasonal flu intensified the attention (according to the World Health Organisation there were 12,799 confirmed HlNl flu deaths worldwide as of the beginning of January 2010 (WHO 2010)). Even if this number is a two to six-fold undercount, as some would argue,1 there were still far fewer HlNl flu deaths in 2009 than the 250,000 to 500,000 per year normally attributed to seasonal flu (WHO 2003). That the outbreak was negligible relative to the calamitous loss of millions of lives predicted by health professionals and officials (PCAST 2009; Syal 2009) made for still sharper scrutiny of the response to the socalled pandemic. By late 2009, concerns were raised about conflicts of interest on the part of flu experts (Engdahl 2009). A resolution passed in December 2009 by the Assembly of the Council of Europe called for an enquiry into the influence of vaccine makers on the World Health Organisation's (WHO'S) flu policy, reflecting suspicions of arm-twisting or collusion (Silverman 2010). Accusations of hype came from both the democratic left (Chin 2009) and libertarian right (Daily Bell 2010); from vaccine supporters who feel that the overstatement of the swine-flu threat diminishes the public's faith in immunisation in general, and those who believe vaccines induce autism. What makes flu an epidemic? What makes any epidemic a threat? How much should the public be asked to sacrifice? How much money? How much liberty? In order to defend against the predicted catastrophe? Answering these questions requires delving into the history of vaccination. Germ Theory and the 1918-1919 Flu By the time the terrible influenza outbreak of 1918-19 had passed, the global toll was at least 20 million dead-although the true number of casualties is unknown, because so many died where disease surveillance was rudimentary, or simply died too suddenly to allow for official tallies (Johnson and Mueller 2002; Taubenberger and Morens 2006). The so-called Spanish Flu epidemic should have discredited the new germ theory, since its proponents were unable to do anything to ease the disaster (the influenza virus was not discovered until 1931). …
This article describes a new approach to assessing the impact of needle- and syringe-exchange pro... more This article describes a new approach to assessing the impact of needle- and syringe-exchange programs (NSEPs), designed for application in Eastern Europe and the former Soviet Union. In these parts of the world, use of a homemade opiate preparation made from poppy plants is common. The advance of AIDS has been associated with increasing use of this drug. However, NSEP might be less effective in that setting than in the West: with a liquid drug, virus transmission may take place through sharing or selling of the drug itself, even when each user has his or her own works and never shares them with others. NSEPs can be difficult to evaluate, however, particularly where users are stigmatized. Here, we propose methods to assess the community impact of NSEPs by evaluating syringes, not users. These methods involve labeling, tracking, and enumeration of syringes as well as testing of syringes for parenterally transmissible virus (e.g., human immunodeficiency virus). They allow for estimation of the total number of syringes in circulation, the average time each syringe spends circulating among users, and the rate of virus exposure among users. Examples are given of the implementation of these methods in Poland, with assessments of the community impact of local NSEPs there.
Research in the Social Scientific Study of Religion, Volume 19
Children at Risk is a theme of modern American life, a set of claims that children's behavior in ... more Children at Risk is a theme of modern American life, a set of claims that children's behavior in the areas of drug use, diet, and sex are not merely potential health threats to some children but real pathologies to all. This essay argues that adults center our health concerns around children's behavioral problems because we are uncomfortable with our own appetites, and lack the moral resolve to decide if we must protect children from them or teach them to deal with the world as it is. It demonstrates that American children are generally healthy, and not much in peril from unmanageable risks. It argues that adults' insistence on childhood "innocence" deprives us of the capacity to take a nuanced and realistic look at children's activities, instead expressing our moral irresolution. And it suggests that the lack of agreement over how children should be involved in research on health problems is a particularly pressing area where moral resolve is needed.
Recent reports indicate that community-acquired methicillin-resistant Staphylococcus aureus (MRSA... more Recent reports indicate that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing and may now involve persons without risk factors predisposing for acquisition. To estimate the extent of community MRSA in New York City, the prevalence of S. aureus and MRSA nasal colonization in a well-patient population of 500 children and guardians was determined. The prevalence of S. aureus nasal carriage was 35% for children and 28% for guardians. One person with predisposing risk factors was colonized with an MRSA, which was identified as the predominant clone found in New York City hospitals. A high degree of methicillin-susceptible S. aureus strain diversity was noted, with no apparent selection for specific clonal types. Thus, MRSA colonization is not ubiquitous in persons without predisposing risk outside of the health care environment. Bacterial competition and a lack of strong selection may limit the community spread of MRSA and can account for its sporadic distribution.
The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease manag... more The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease management, but also highlights the nature of contemporary public health: an endeavour primarily geared toward protecting the current political economy of the developed world and promoting middle-class moral propriety. Understanding how today's flu response is shaped requires insight into the history of germ theory; the development of new ways of thinking about the role of immunisation in the public sector; the public health industry's turning away from earlier concerns with social structure, poverty, discrimination, and access to resources; and, the development of a focus on individual behaviour. Close inspection of two important events in immunisation history-the creation of the polio vaccine in the 1950s and the American swine-flu fiasco of 1976-yields new awareness of the contemporary collusion between public officials and wealthy corporations, and helps to reveal how public health serves existing power structures. Introduction Almost everyone has taken some interest in epidemics of late. The noisy response to the epidemic of 2009, the H1N1 swine flu, made sure of that. Society certainly made too much of swine flu (many have blamed the media for that) (Brownstein 2009). Although some found people too complacent, or gratingly uncooperative with flu-control programs (Chan 2009; Shuchat 2009; Butler-Jones 2009), others thought too little attention was being paid to epidemics that seemed more important, like autism, obesity, attention-deficit/hyperactivity disorder (ADHD), or the auto-immune deficiency virus, AIDS (McKay 2009). The debate crystallised around campaigns to immunise whole populations against H1N1 flu. That the swine flu outbreak was comparatively mild relative to outbreaks of common, seasonal flu intensified the attention (according to the World Health Organisation there were 12,799 confirmed HlNl flu deaths worldwide as of the beginning of January 2010 (WHO 2010)). Even if this number is a two to six-fold undercount, as some would argue,1 there were still far fewer HlNl flu deaths in 2009 than the 250,000 to 500,000 per year normally attributed to seasonal flu (WHO 2003). That the outbreak was negligible relative to the calamitous loss of millions of lives predicted by health professionals and officials (PCAST 2009; Syal 2009) made for still sharper scrutiny of the response to the socalled pandemic. By late 2009, concerns were raised about conflicts of interest on the part of flu experts (Engdahl 2009). A resolution passed in December 2009 by the Assembly of the Council of Europe called for an enquiry into the influence of vaccine makers on the World Health Organisation's (WHO'S) flu policy, reflecting suspicions of arm-twisting or collusion (Silverman 2010). Accusations of hype came from both the democratic left (Chin 2009) and libertarian right (Daily Bell 2010); from vaccine supporters who feel that the overstatement of the swine-flu threat diminishes the public's faith in immunisation in general, and those who believe vaccines induce autism. What makes flu an epidemic? What makes any epidemic a threat? How much should the public be asked to sacrifice? How much money? How much liberty? In order to defend against the predicted catastrophe? Answering these questions requires delving into the history of vaccination. Germ Theory and the 1918-1919 Flu By the time the terrible influenza outbreak of 1918-19 had passed, the global toll was at least 20 million dead-although the true number of casualties is unknown, because so many died where disease surveillance was rudimentary, or simply died too suddenly to allow for official tallies (Johnson and Mueller 2002; Taubenberger and Morens 2006). The so-called Spanish Flu epidemic should have discredited the new germ theory, since its proponents were unable to do anything to ease the disaster (the influenza virus was not discovered until 1931). …
ESPITE THE INTRODUCTION OF the first antituberculin drugs almost 50 years ago, morbidity and mort... more ESPITE THE INTRODUCTION OF the first antituberculin drugs almost 50 years ago, morbidity and mortality associated with Mycobacterium tuberculosis remains a major public health threat. Recently, the study of tuberculosis (TB) epidemiology and transmission, traditionally accomplished by patient contact tracing, has been augmented by the use of molecular strain typing. A striking example was the identification of the W strain, a multidrug-resistant (MDR) clone that caused disease in more than 350 patients in New York City and accounted for more than 25% of all MDR cases in the United States in the early 1990s. 1-4 This MDR and successful clone, associated with high mortality rates in both New York prisons and hospitals, has since become the "index" strain in the Public Health Research Institute (PHRI) TB Center (New York, NY) and has been the focus of a number of molecular epidemiological studies. 1-6 It is generally accepted that M tuberculosis isolates with identical inser-Author Affiliations are listed at the end of this article.
Journal of acquired immune deficiency syndromes and human retrovirology, May 1, 1996
Cytomegalovirus (CMV) infection remains a life-threatening infection in patients with HIV disease... more Cytomegalovirus (CMV) infection remains a life-threatening infection in patients with HIV disease. A rapid, quantitative diagnostic technique is needed to adi in the diagnosis of CMV disease. This study was undertaken to evaluate the CMV antigenemia test in patients with HIV disease who are at risk for CMV disease. The study included 22 patients who underwent ophthalmologic exams or selected diagnostic techniques in whom CMV cultures and CMV antigenemia tests were performed. All of 11 patients with CMV disease had positive CMV antigenemia assays [range, 48-1,000 positive cells/2 x 10(5) peripheral blood leukocytes (PBL)], and 10 were also CMV viremic. There was no clinical evidence of CMV disease in 11 patients, including seven in whom the CMV antigenemia assay was negative and who remained without evidence of CMV disease after a median follow-up of 159 days. Four patients had low antigenemia levels. Of these four, two subsequently developed CMV retinitis. In conclusion, a positive CMV antigenemia result with > or = 48 positive cells/2 x 10(5) PBL correlated with concurrent CMV disease. The CMV antigenemia test appears to be a valuable tool for the rapid diagnosis of CMV disease in HIV-infected individuals.
Changes in the level of CD4-bearing T-lymphocytes in injection drug users infected with the human... more Changes in the level of CD4-bearing T-lymphocytes in injection drug users infected with the human immunodeficiency virus were evaluated in a sample of 318 subjects enrolled from a methadone program in the Bronx, New York, from 1985 through 1989. Follow-up continued through 1990. The percentage of CD4+ T-lymphocytes (CD4%) was used to maximize the stability of measurements. The rate of decline of the CD4% was determined using a random-effects assumption, and predictors of rate of decline were evaluated using an autoregressive model. The rate of CD4% decline was approximately 1.2 CD4% lost per 6 months, with a higher rate in recent seroconverters (2.2 CD4% lost). The most important predictors of decline of the CD4% in autoregressive models were current pyogenic bacterial infection (CD4% reduced by 2.75, 95% confidence interval (CI) 0.42-5.08), current report of a second constitutional symptom (CD4% reduced by 2.16, 95% CI 0.03-4.29), and history of bacterial infection (CD4% reduced by 1.49, 95% CI 0.09-2.89; proportion of prior CD4% lost increased by 0.14, 95% CI 0.01-0.27). Oral thrush was not related to an accelerated rate of CD4% decline.
Yale Journal of Health Policy Law and Ethics, 2013
Wide gaps in health status, access to health care, quality of care, and provision of health-relat... more Wide gaps in health status, access to health care, quality of care, and provision of health-related services are increasingly evident in the context of globalization. In the face of glaring disparities between the health status of the "Haves" and that of the "Have Nots," health professionals in wealthier countries must consider the impact of such disparities on the ethical conduct of health research. Unfortunately, currently established codes of moral conduct fail to provide adequate guidance for ethical decision-making in health research. Formal codes include the U.S. Department of Health and Human Services (DHHS) regulations for protection of human subjects, the Nuremberg Code, the Helsinki Declaration, and the guidelines of the Council for International Organizations of Medical Sciences Taken together, these documents constitute a body of important standards for protecting research subjects from harm and regulating the balance between potential risks to subjects and potential benefits. Yet, these standards fail to resolve ethical conflicts between upholding human rights and producing more information for medical benefit. Such conflicts are increasingly apparent as economic globalization reveals the depth of international disparities in resources and knowledge. In this Article, we examine how an ethics based on caring and responsibility can guide clinical research in a manner that is consistent with human rights and justice in the face of global disparities. We review two paradigms for moral reasoning-the morality of rights and the morality of care-with respect to applying the principles of human rights to health. The morality of rights relies on the abstract concept of justice to guide behavior. The morality of care, as the name suggests, seeks to guide decision-making in a way that takes care of others, examining real-world conflicts and contexts to resolve moral dilemmas. As such, it can
The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease manag... more The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease management, but also highlights the nature of contemporary public health: an endeavour primarily geared toward protecting the current political economy of the developed world and promoting middle-class moral propriety. Understanding how today's flu response is shaped requires insight into the history of germ theory; the development of new ways of thinking about the role of immunisation in the public sector; the public health industry's turning away from earlier concerns with social structure, poverty, discrimination, and access to resources; and, the development of a focus on individual behaviour. Close inspection of two important events in immunisation history-the creation of the polio vaccine in the 1950s and the American swine-flu fiasco of 1976-yields new awareness of the contemporary collusion between public officials and wealthy corporations, and helps to reveal how public health serves existing power structures. Introduction Almost everyone has taken some interest in epidemics of late. The noisy response to the epidemic of 2009, the H1N1 swine flu, made sure of that. Society certainly made too much of swine flu (many have blamed the media for that) (Brownstein 2009). Although some found people too complacent, or gratingly uncooperative with flu-control programs (Chan 2009; Shuchat 2009; Butler-Jones 2009), others thought too little attention was being paid to epidemics that seemed more important, like autism, obesity, attention-deficit/hyperactivity disorder (ADHD), or the auto-immune deficiency virus, AIDS (McKay 2009). The debate crystallised around campaigns to immunise whole populations against H1N1 flu. That the swine flu outbreak was comparatively mild relative to outbreaks of common, seasonal flu intensified the attention (according to the World Health Organisation there were 12,799 confirmed HlNl flu deaths worldwide as of the beginning of January 2010 (WHO 2010)). Even if this number is a two to six-fold undercount, as some would argue,1 there were still far fewer HlNl flu deaths in 2009 than the 250,000 to 500,000 per year normally attributed to seasonal flu (WHO 2003). That the outbreak was negligible relative to the calamitous loss of millions of lives predicted by health professionals and officials (PCAST 2009; Syal 2009) made for still sharper scrutiny of the response to the socalled pandemic. By late 2009, concerns were raised about conflicts of interest on the part of flu experts (Engdahl 2009). A resolution passed in December 2009 by the Assembly of the Council of Europe called for an enquiry into the influence of vaccine makers on the World Health Organisation's (WHO'S) flu policy, reflecting suspicions of arm-twisting or collusion (Silverman 2010). Accusations of hype came from both the democratic left (Chin 2009) and libertarian right (Daily Bell 2010); from vaccine supporters who feel that the overstatement of the swine-flu threat diminishes the public's faith in immunisation in general, and those who believe vaccines induce autism. What makes flu an epidemic? What makes any epidemic a threat? How much should the public be asked to sacrifice? How much money? How much liberty? In order to defend against the predicted catastrophe? Answering these questions requires delving into the history of vaccination. Germ Theory and the 1918-1919 Flu By the time the terrible influenza outbreak of 1918-19 had passed, the global toll was at least 20 million dead-although the true number of casualties is unknown, because so many died where disease surveillance was rudimentary, or simply died too suddenly to allow for official tallies (Johnson and Mueller 2002; Taubenberger and Morens 2006). The so-called Spanish Flu epidemic should have discredited the new germ theory, since its proponents were unable to do anything to ease the disaster (the influenza virus was not discovered until 1931). …
This article describes a new approach to assessing the impact of needle- and syringe-exchange pro... more This article describes a new approach to assessing the impact of needle- and syringe-exchange programs (NSEPs), designed for application in Eastern Europe and the former Soviet Union. In these parts of the world, use of a homemade opiate preparation made from poppy plants is common. The advance of AIDS has been associated with increasing use of this drug. However, NSEP might be less effective in that setting than in the West: with a liquid drug, virus transmission may take place through sharing or selling of the drug itself, even when each user has his or her own works and never shares them with others. NSEPs can be difficult to evaluate, however, particularly where users are stigmatized. Here, we propose methods to assess the community impact of NSEPs by evaluating syringes, not users. These methods involve labeling, tracking, and enumeration of syringes as well as testing of syringes for parenterally transmissible virus (e.g., human immunodeficiency virus). They allow for estimation of the total number of syringes in circulation, the average time each syringe spends circulating among users, and the rate of virus exposure among users. Examples are given of the implementation of these methods in Poland, with assessments of the community impact of local NSEPs there.
Research in the Social Scientific Study of Religion, Volume 19
Children at Risk is a theme of modern American life, a set of claims that children's behavior in ... more Children at Risk is a theme of modern American life, a set of claims that children's behavior in the areas of drug use, diet, and sex are not merely potential health threats to some children but real pathologies to all. This essay argues that adults center our health concerns around children's behavioral problems because we are uncomfortable with our own appetites, and lack the moral resolve to decide if we must protect children from them or teach them to deal with the world as it is. It demonstrates that American children are generally healthy, and not much in peril from unmanageable risks. It argues that adults' insistence on childhood "innocence" deprives us of the capacity to take a nuanced and realistic look at children's activities, instead expressing our moral irresolution. And it suggests that the lack of agreement over how children should be involved in research on health problems is a particularly pressing area where moral resolve is needed.
Depictions, journal of the Paris Institute for Critical Thinking, 2021
The coronavirus outbreak is an intensification of a pre-existing state of emergency in the West. ... more The coronavirus outbreak is an intensification of a pre-existing state of emergency in the West. That condition has become possible through the cultural reception of social science data as evidence that the human will takes precedence over material conditions in shaping history. Epidemiology has been particularly instrumental in contributing to the sense that prudence—behavioral propriety—is the main hedge against death. The state of emergency reanimates death not as a normal part of life but as an offense; failing to follow the prescriptions said to allow death to be avoided implicates the individual in the preoccupying crisis, be it coronavirus, the earlier crises of AIDS and obesity, or the inevitable next one.
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Papers by Philip Alcabes