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      As many have heard, John Tory, the mainstream right wing candidate, won convincingly in Toronto and Olivia Chow came in third place, even doing worse than Doug Ford (brother of the famous crack-smoking Rob Ford.)  Much hand wringing has ensued that progressive just can’t win elections in Toronto. While it’s true that Toronto is hard [...]
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Ghost Stories

I listen to a variety of podcasts.  Yes, my best beloveds, you would be surprised at the wide range of podcasts I listen to.  One of my favorite podcast hosts is Seth Andrews over at The Thinking Atheist.  He’s got one of the best non-consensus reality podcasts out there.  You don’t have to be an atheist to enjoy it.  Plus, he’s got the best voice in the podcast universe.

Every year at about Halloween, he does a special Ghost Story episode.  This year doesn’t disappoint.  The “Two sentence ghost stories” that are included in this year’s episode truly freaked me out.  Seth shows that even atheists are people who like a good story – and traditional holidays – just like everyone else.

So, get your hot chocolate, turn down the lights and gather round your computer for The Thinking Atheist Podcast Ghost Stories 2014.  Bwahahahahahahhhhhhh!

And if you liked that, check out:

TTA Ghost Stories 2013

TTA Ghost Stories 2012

No, no, don’t thank me.  Thank Seth.

Apollo 11, West Africa and Eyelids

I lived in Pearl Harbor when Apollo 11 went to the moon and back.  They used slide rules to make calculations back then.  Those guys were launched into space while sitting on a giant firework.  They got to the moon, made it back in one piece…

…and spent three weeks in an isolation unit in Hawaii.  They were heroes.  They deserved a ticker tape parade.  And they waited patiently until they were cleared of any nasty moon germs before they got it.

I understand Anthony Fauci’s concern that a mandatory quarantine will discourage volunteer health care workers at a time of crisis in West Africa.  However, the problem is a cultural one.  Here in the US, workers get very few vacation days.  If you spend them all in an Ebola hospital in Monrovia, it is an unfortunate likelihood that your employer is going to be unsympathetic to your do gooder status when you get stuck in Newark for three weeks.  That’s why I think politicians need to move on protecting workers from losing their salaries and jobs when they come back.

Nevertheless, I think Cuomo, de Blasio and Christie have done the right thing by mandating a quarantine for a very limited number of people coming in from West Africa to New York and New Jersey ports.  That’s because the NYC-NJ megalopolis is the most densely packed area of the country and an outbreak of ebola there could have a devastating impact.  If health care workers are diverted to less crowded areas of the country to disembark in order to avoid detention in Newark, then the quarantine may have served its purpose.

(Update: DeBlasio and Cuomo have moderated their quarantine policy and I approve their changes.  They will allow health care workers that are high risk to remain at home during the isolation period.  They will be monitored by public health officials twice a day AND they will be compensated for lost income.  There’s a lot to like here.  The twice a day monitoring should help to keep the person off the streets, subways and buses.  The compensation for lost income should assure volunteers that they’re not going to be punished for doing good things.  Christie hasn’t changed his policy yet.  Not sure where Hickox is from but she might have to tough it out in Newark until she’s been cleared to travel on domestic airlines.  I’m betting that no American airlines wants to have another Frontier incident.)

It would be the equivalent of keeping ebola infected individuals out of Kinchasa or Lagos, as Michael Osterholm explains in the video below from Johns Hopkins Ebola Forum a week or so ago.  This video emphasizes why it is so important to contain the outbreak in West Africa and why it is almost too late to do so.  Well worth the viewing.  Not too nerdy or complicated.

Finally, this article from the New Yorker illuminates the problems with diagnosing ebola and protecting health workers.  Inside the Ebola Wars is a must read. (Also not too geeky) Here are some things I learned from it that makes me think that quarantining Kaci Hickox was probably not a bad idea:

  • The diagnostic test for ebola was developed on an old strain of the virus.  For the current two strains, it has become much less accurate and may be an unreliable confirmatory test for ebola.
  • Dr. Kent Brantly was symptomatic when he went into isolation in Africa and had his blood sent for confirmation of ebola.  The test came back negative.  A few days later, Brantly was much sicker and had a second test.  This one was positive.  So, if Kaci Hickox is making the case that she shouldn’t be stuck in Newark (well, who should?  I wouldn’t wish it on my worst enemy) based on her ebola tests, she’s full of s#*}.  There’s no way to know whether she is carrying the virus until she gets sick. That could still happen.  So, I’d stop giving the general public the idea that I’m imprisoned on false pretenses.  First, it’s not imprisonment and second, we don’t know yet and neither does she.  That’s the whole point of a quarantine.
  • There has been some speculation as to how some health care workers are getting infected in spite of their expertise with PPE.  A proposed route is that a tiny droplet of infected bodily fluid is getting trapped behind the moist eyelid of the health care worker.  How it got there is anyone’s guess.  Maybe it’s a chance encounter with an tainted gloved hand.  Maybe its aerosolization.  No one knows yet.
  • A single viral particle can kill you.  Well, it has to replicate like bunnies in your body but it only takes one.  And a single drop of blood or sweat contains billions and billions of viral particles.  Yep, think that over and now project that onto the map of New York City and New Jersey.  {{shudder}}

Still not panicking but I am relieved that there are people trying to prevent an outbreak.  This is not a Texas scenario and for that we should be grateful.

Just because you’re a saint doesn’t mean you’re not infectious

Update: Kaci Hickox’s real friends should have a good long talk with her about her over-reaction to the quarantine for a very good reason.  Hickox does not know what her infection status is.  That’s because the diagnostic for ebola isn’t accurate until a person displays symptoms.  If it turns out that in a couple of days she does get sick, she and all her defenders who are trying to make her out to be a martyr to New Jersey’s oppressive public health system are going to suffer a severe backlash that will undermine their credibility.  Is that wise?? I mean, with all of the lunatic Republicans ready to seal the US off from the rest of the world, do we really need a potentially sick Nurse Hickox to become a poster child for ebola?  I’m surprised that they aren’t thinking about this and begging Hickox to dial it back and set a better example for others to follow.

Also, I am going to reiterate my suggestion to the politicians to work on getting employers to pay the salaries of employees who are involuntarily quarantined, make it possible for those who can work remotely to do so, and prevent discrimination when they return to work.  It’s part of their civic duty.  Oh, and get the states that refused to extend Medicaid to pay for the treatment of indigent patients.  Better to get in front of the problem now.  Ebola is not the only nasty disease in the world.

**********************************************************

I’m blogging from my iPhone because I am irritated with nurse Kaci Hickox’s pathetic whining about being put in quarantine when she returned from Sierra Leone after she treated ebola patients.

Apparently, she is taking umbrage at the fact that she was quarantined in NJ and they were terse with her.  She doesn’t have a fever, says she.  But Dr. Spencer also thought he was magically free of ebola when he returned from West Africa. He was so confident of his superpowers to fight off infection that he rode the subway while he was just shy of being violently ill.

Presumably, Dr. Spencer and other healthcare workers should be aware that they are not invincible and should keep themselves off of public transportation. But we have learned, much to our chagrin, that overconfidence trumps sanity and consideration for the lives of others. I don’t think a travel ban is necessary or useful but it is apparently necessary to keep an eye on health care workers if for no other reason than to keep major metropolitan areas from freaking out.

Quarantines used to be common back in the olden days when we didn’t have cures for deadly diseases, nurse Hickox. (See this PBS Nova primer on the history of quarantine) You are not special. Ebola doesn’t care how self-sacrificing you are.  If you are truly as good and wonderful as you say you are, you will take an old cold tater and wait out your time in isolation. You aren’t a criminal. Just a possible carrier. Grow up.

More on the quarantine: Viral infections don’t have a political ideology but our responses to them apparently do.  Republicans are nauseatingly reflexive when it comes to saving themselves at the cost of pissing off every other interest and people who voluntarily put themselves in danger to aid others.  Some lefties have their minds so wide open that their brains have fallen out and they move too far in the “there’s nothing to worry about, you stupid yahoos” camp.

There most certainly is something to worry about.  The epidemic in West Africa is a genuine crisis that has global implications if it is not controlled.  Ebola has no cure and we don’t know if any vaccine developed so far is safe or effective.  Likewise, we don’t know if ZMapp even works.  Add to this the absence of a “pee on a stick” diagnostic that would allow us to identify infected people before they potentially get on a subway and throw up on everyone within a three meter radius. This is no time to become complacent.

Quarantines are not prison sentences and anyone exaggerating the horrors of involuntarily detention in New Jersey* due to possible infection of a deadly disease is as careless and irrational as the morons calling for us to seal off our borders.  Stupidity, like viral infections, does not respect political affiliation.

One more thing: Yes, Yves, all bodily fluids are potentially infectious once people start getting sick.  Since we don’t know when they will cross that threshold from being merely fatigued to feverish, sweating and throwing up, it’s best they stay away from public transportation.  And here’s something else that is really disturbing: the ebola virus can persist in semen for up to three months after a victim has cleared it from the rest of his body.  So, there, Yves.  Look it up.

* Kaci Hickox’s complaints about her treatment sound like a litany of first world problems.  She was given a granola bar when she told her detainers that she was hungry.  She was held in a “tent” on the grounds of the hospital and it was unheated.  Please.  We’re having a nice Indian Summer here in the Northeast.  Put a fricking sweater on. (Now, she’s complaining to her mother that cell phone reception sucks in her isolation unit.  It’s NEWARK, for Pete’s sakes.  Cell phone reception is notoriously spotty anywhere in the Newark-Manhattan area.  New Jerseyans have to put up with this all year round.  The cell tower is not singling you out.)  Really, you’d think she’d just spent a month at Club Med instead of one of the poorest countries in the world.  I’m embarrassed for her.  Apparently, she’s never volunteered to provide health care in parts of North Philly where there is genuine American hardship and poverty that is rapidly devolving into third world conditions.  Hard to believe she made the front page of the NYTimes with her sob story.

In which I differ with Derek Lowe over NIH funding

Typical private industry lab circa 2014

Derek Lowe, blogmaster over at In the Pipeline, took issue with NIH Director Frances Collins contention that if the NIH budget hadn’t been cut in the past decade, we might have had an ebola vaccine by now.  I remarked on the Vox article about this very same topic last week.  However, I’m siding with Collins on this topic.  True, he might be using the very scary disease of ebola to make his point but it is a valid one.

To get an idea of what the NIH has been up against, I recommend that readers review the congressional testimony on the ebola outbreak from last week.  I believe it was Anthony Fauci who laid out the problem.  It goes like this:

  1. The NIH identified the need for an ebola vaccine about a decade ago.
  2. (This is the crucial part) The NIH is engaged in basic research.  We are talking very, very basic research.  Like, identifying the genes and sequences and making them available to other researchers, or studying how the virus works and propagates, or figuring out which enzymes chop up the viral proteins, or how the viral proteins are exposed to the rest of the body.  That’s the kind of research the NIH does.  And sometimes, the research is so preliminary that there are mistakes that get published that industrial labs have to figure out when they try to replicate the results in the lab.  Not a criticism.  It happens.  You only have so much money to do the research and sometimes, it’s not enough to double check your results.  I get it.  But it does make it harder for your private industry partners to figure out what’s going on and sometimes means that projects need to take detours to unpack mechanisms and rerun assays and such.  In other words, REAL RESEARCH.  That’s just the way science works, much to the finance industry’s chagrin.
  3. So, the NIH tried to get a private industry partner to help finish the research on the vaccine and develop it.
  4. But during the same decade, private industry was going through a chaotic destructive process brought on by the “patent cliff”.  That is, the blockbuster drugs that fueled industry research suddenly went off patent.  In response, the shareholders who were not about to take a haircut just so some lab rats could continue to do research for them, decided to take the money and run.  That precipitated Pharmageddon, where I and my colleagues got tossed out of corporate labs by the hundreds of thousands.
  5. The NIH couldn’t find a private industry partner until the last couple of years when Glaxo Smith Kline (GSK) decided it would take a risk and start working on one.
  6. In the meantime, in the last couple of years, the Republicans have lost their freaking minds over the budget and would rather let every government institution rot in hell before they would approve any funding.  This is about the same time we wrote a blank check to AIG, and other lords of the finance industry (see Neil Barofsky’s book).  Then the Democrats came up with this great idea of a sequester, you know, to call the Republicans bluff.  And the raving mob that calls itself the Republican party took the deal and slashed NIH funding by 20%.  The Democratic leadership that came up with the boneheaded, backfiring sequester idea should be kept away from sharp objects for their own safety.
  7. So, to recap: NIH needed a vaccine but couldn’t find a private partner for nearly a decade.  Private industry contracted at a time when additional research and development is crucial.  Regular NIH funding is not sufficient for it to develop a vaccine on its own.

This would probably be a good time to insert some Paul Krugmanesque graph that shows the equilibrium between private and public investment in scientific research.  This one should show that when private industry stopped funding research, the corresponding expected increase in public spending was notably absent.

Derek has a libertarian streak and works for one of the last small molecule drug discovery companies in Cambridge.  That’s not necessarily a bad thing but it does skew his perspective just a tad.  Not only that but Derek is operating in the old world order when we tested every therapeutic treatment to death.  That’s clearly not happening with the ebola treatments.  Those suckers have been fast tracked like nobody’s business.  We are treating ZMapp like it’s a cure for ebola when it’s nothing of the sort.  It’s just that it’s the only thing we’ve got.  ZMapp is so early in development that back in the old days of real drug discovery, it might have been killed in a project portfolio review before it ever made it to development.  And the vaccines?  Well, normally, they’d go through many stages of development and testing for safety, efficacy, and side effects with an expanding number of trial recipients at each stage before it was approved by the FDA.  Forget that.  In this epidemic in West Africa, with number of exposures increasing exponentially, no one has time for these niceties (though I can just see some lefties screaming about how we killed West Africans with an untested vaccine that triggered a cytokine storm or autoimmune disease.  Wait for it.  You know it’s going to happen.  There will probably be a movie about it featuring some ruggedly handsome Liam Neesom type and a earnestly beautiful lady scientist detective out to uncover the awful truth of corporate exploitation of poor third world citizens.).

The real world is not so simple but there definitely is money at the bottom of this mess.

I’ve worked on both sides of the problems in both industry and in academia, if only briefly.  But I got a good look at what it’s like to do research on NIH grant money and it’s not pretty.  Most of a principal investigator’s time is spent preparing grant applications.  It’s very bureaucratic and, I suspect, very political.  If there isn’t a retrospective analysis on the amount of grant money that goes to the Ivies that leave the rest of the academic labs starving for funds, there really should be.  Not every breakthrough has to happen at Harvard.  The polio vaccine, for example, was developed in Pittsburgh.  Oh, yeah, how many of you knew that Jonas Salk worked for the University of Pittsburgh? True story.

And yet, it was about a year ago that I got a call in my office at Pitt from a researcher in the immunology group who had just lost her job because of the sequester.  It was last year at about this time that we had to cut back sharply on ordering chemicals and lab supplies for my lab because grants were on hold, also due to the sequester.  Even today, I see positions at Pitt for the kind of work that I used to do but the hours are part time.  Really??  You expect scientists to do protein production, extraction and crystallization experiments on a part time basis?  That’s the craziest thing I have ever seen.  You can’t just interrupt an experiment half way through the week because you’ve run out of hours.  That makes me think that the people posting the positions aren’t serious about how many hours they expect the researcher to be available.  It’s deceptive and weird and unrealistic.  But that’s life on soft money.  Here today, gone the next.  Yet the cells still need to be fed, lysed, protein collected, spun, purified, etc, etc, etc.

Friends, Americans, countrypersons, this is no way to run a research infrastructure.  Ok, sure, it’s the way to run a research infrastructure if you don’t want to do it like Americans used to do it.  If you are content to run a research infrastructure like Bolivians do it, fine, do it this way.  But don’t complain later that nothing of significance happened on the science front from 2008 onward.  Don’t complain that the NIH is not telling the truth about funding.  It can’t be all things to all people without a steady funding mechanism that isn’t going to be subject to violent shocks brought on by crazy people who get elected to Congress.

Here’s the bottom line.  If liberals expect the NIH to do all of the things that they *think* it already does, it needs more funding.  It needs waaaaaaaay more funding than it already has.  It needs as much funding as private industry used to pump into its own research coffers but no longer does.  It needs billions and billions more.  It has to become what private industry used to be but no longer wants to be.

And if Republicans are committed to free enterprise at all costs, it’s going to have to get tough with private industry drug discovery and force it to take on research that it sees as unprofitable.  It needs to have a serious talk with the bonus class and shareholders about greed at the expense of public health.  Isn’t that what the GOP is all about?  Morality?

That’s just the honest truth.  The NIH is not private industry.  If we want the NIH to replace private industry, which has abandoned certain, critical research areas because it can’t make the kind of profits that shareholders demand nowadays, we need to put more money into the NIH and fund researchers properly and seriously.  That is the point that Frances Collins has been trying to make.

Liberals have a complete misunderstanding of what the NIH does or is capable of doing.  Libertarians have an inflated view of what private industry can do, sometimes because they are living in one of the last holdouts of productive private industry drug discovery (that could end at any time, so don’t get too comfy, Derek).  But once you have lived in both worlds, you can see what a shambles the whole system is.  It’s unsettling and alarming.

We’re Royals and other updates

Just for the record, we’re Royals fans for this World Series in honor of Katiebird who lives in Kansas.

Oh, and there’s a confirmed case of Ebola in NYC.  This time it’s a doctor who just returned from West Africa and *should* have been keeping himself off of public transportation.  Alas, he took a train from Manhattan to Brooklyn to go bowling the night before his temperature soared to 103º.  Way to go, Dr. Spencer.  You’re giving Texas a run for its money.

Let’s see if Belleview Hospital and the dirty effing hippies who run NYC do a better job of containment.  I’m going to bet that Manhattan takes it in stride.  I mean, it’s not like two planes smashing into the tallest buildings around.

Still no reason to panic.

Cue the Lorde tune:

Give Democrats a piece of your mind

The mid-term election is only weeks away and despite the lack of recovery for the vast majority of us, life is about to get a whole lot harder as the Senate is predicted to fall into the Republicans’ hands.

That leaves us with Barack Obama to guard the door from the lunatics.  In other words, we’re totally screwed.

But why sink into despair?  If you’re disappointed and angry at the way the last six years (and two to go) have turned out, you probably have good reason to be in spite of what Paul Krugman says.  The Democrats are not the Chicago Cubs.  We do not have to feel all sentimental about having a losing team all the time.

So, vent.  Get it all out.  What pisses you off the most about how the Democrats have let us down?  Don’t be afraid to tell it like it is.  Civility is for cotillions.

These student body president types may be perfectly content to ignore you or they may have absolutely no idea why you’re about to allow them to be voted out of office.  Put them on notice in the comments below.

Registered Democrats only please.  If you’re a Republican, Tea Party troublemaker or independent, please sit on your hands.

I’ll go first.  Unemployment is still high for those of us 45-65.  Wages are pathetic.  But the thing that ticks me off the most is how Obamacare 1.) created two classes of American workers, 2.) did nothing to control costs, and 3.) forced the second class Americans without employer based health care into high deductible, tiny network, expensive insurance plans.  Even with the subsidies, which many of us don’t get because we make too *little* money (like that’s supposed to make any damn sense), the plans are unaffordable.  Krugman can go jump in a lake for all I care.  Obamacare is awful.

Ok, your turn.

Why Ebola spread in Dallas: Americanism

Lorenzetti’s Allegory of Good Government, 1339

We’re number one.  That’s what we always tell each other.

We have the best health care in the world.

Our public safety institutions are number one in the world.

We  are the richest country in the world.

We are supremely over confident.

How many people know that when Dr. Kent Brantley and Nancy Writebol returned from Liberia with ebola that their care was paid for by Samaritan’s Purse?  I’ll bet a lot of us just assumed that the US government picked up the tab for the flight, biocontainment units, ZMapp doses and hospital stays.  Not so.  So, who is paying for the transport and treatment of Nina Pham and Amber Vinson?

Probably a few more of us have questioned whether money was behind the shoddy care that Mr. Duncan got in Texas.  I have.  I’m betting that his lack of insurance and status as a foreign national had a lot to do with why he wasn’t immediately isolated when he first came to the hospital and why he was left in the ER for hours, some nurses say days, before he was transferred to a critical care unit.

As for the best health care in the world, the nurses were very unprepared for ebola.  The biggest chunk of the blame goes to the hospital.  It’s a hospital for the middle class and those who can afford the best health care in the world.  That’s where people go to have their babies and bypass operations.  Maybe they didn’t associate their kind of hospital with an epidemic in a third world country.  Bad things happen to THOSE people over there in Africa.  Not their kind of people in Dallas.  At best, that’s a benign form of American narcissism.  We’re so used to having clean water and streets and good food.  So, why should the hospital get all Girl Scouty and be prepared for a situation that will never happen to it?  Training for such an eventuality takes time from nurses doing their duties and time is money.  It’s the American way.

The CDC seems to have vastly overestimated the outcomes of our educational institutions, especially our K-12 schools, where everyone should have a pretty good understanding as to where Liberia is.  But then again, Liberia was a state created by former American slaves in the 19th century and Texas is a state notorious for trying to rewrite the past when white Americans might have done bad stuff to anyone.  But still, don’t these ER intake people, nurses and doctors watch the news??  At least one nursing supervisor seems to have been on the ball and insisted on moving Mr. Duncan to an isolation unit instead of letting him shed viruses all over the ER but she was shot down by her administration.  Still, you’d think that a hospital so concerned with its reputation and profits would have been more proactive in limiting the damage that his presence was causing.  Not so, apparently.

And what was the hospital thinking when they gave antibiotics to Duncan when they hadn’t bothered to find out whether he  had a bacterial infection that required them?  Does Texas Health Presby Hospital routinely overprescribe antibiotics?  Is this a hospital or a student health center?

What were Republicans and Democrats thinking when they cut the budget for the CDC by 12% and the NIH by 20%?  Friedan said yesterday that $30 million was restored earlier this year in an “anomaly”.  How the hell are you supposed to prepare for emergencies if you never know what your budget is going to be from one year to the next?  We complain about administrators making decisions for our health care instead of physicians but our bigger problem is that we have politicians making decisions for our disease fighting institutions.  Should the CDC and NIH know in advance what diseases are going to become epidemic on some kind of 5 year plan and ask for the right budget money in advance?  Or are their functions compromised by their unreadiness brought on by this reckless political posturing?

And everyone, politicians, journalists and people who should know better, is under some mistaken belief that the private sector is going to step up and perform the tasks in research and disease prevention that the CDC and NIH were created to do.  But they’re too busy trying to reap profits for the shareholders to engage in such money sucking activities like research. Meanwhile, we underfund the NIH and CDC.  Is that so Republicans can point to what a sh*%%y job government does?  Are they paying no attention to how our scientific infrastructure is being dismantled in this country and concentrated on a few narrow therapeutic areas?  They are leaving a gap that no one is able to fill.

This may be the richest country in the world but the riches are hoarded by some pretty selfish individuals and we don’t seem to be able to get our act together to force them to give up their loot for the greater good.

A little ray of hope came through yesterday when I saw that some television content providers are breaking away from the package deals offered by cable companies to allow viewers ala carte channel selection.  That’s great because eventually I will no longer have to subsidize right wing propaganda from Fox News or be forced to pay for Fox to mislead unsuspecting American viewers.  I’m betting that a lot of like minded individuals across the country will drop Fox from their lineup the second they are able to do it.

But the damage may already be done.  The Senate may fall into Republican hands this November and in the next two years, the predators who have been stalking us since FDR got us out of the Great Depression will finally be able to finish us off.   The willfully ignorant elderly and angry white males will finally stick a fork in us, and allow the extremists to carelessly destroy Social Security, roll back women’s rights and plunge us back into recession with unrestrained austerity.  The only thing that will stand between the power extremists and us will be Barack Obama.  That right there is a very depressing scenario.  But maybe he will have the courage to stand aside when we finally pick up our torches and pitchforks.

We have been living a myth of our greatness.  We’ve been in denial about how government works.  We have told ourselves lies about how we can “starve the beast” that once made our country a formidable force of good around the world.

I’m only glad that the ebola crisis here will be under control before the next session of Congress begins and before the gung-ho, American exceptionalists who take over show us just how unexceptional we are to the hunters who prey on the young, old, and weak.

Section from Lorenzetti’s Effects of Bad Government, 1339

 

More speculation and budget numbers at Angry Bear Blog.

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