Category: Science

Rabies: 9 years and things are not getting better


 rabid dog
For about nine years now, I have been traveling to Baltimore on a semi-annual basis. I go to the Johns Hopkins Bloomberg School of Public Health and deliver, more or less, the same talk, year after year,  about rabies.
9 years, and more deaths.
It’s part of the vector-borne section of the course. While not a vector-borne disease (unless we wish to think of dogs as a vector between us and bats–a bit of a stretch, if you ask me), rabies is considered one of the Neglected Tropical Diseases (NTDs), and because it’s a preventable cause of horrific and needless suffering it needs to be somewhere.
Opening Salvo
I always preface my talk with two informal survey questions:
  1. Does anyone know what the OIE is?
  2. Does anyone know what One Health is?
Answers:
  1. OIE stands for Office International des Epizooties, or World Organisation for Animal Health (yes, they use the British spelling of “organization, which I think is a political statement, but that’s another post). It’s kind of like the WHO for animals, and it is based in Paris.
  2. One Health is a concept advanced by the American Veterinary Medical Association, the CDC, and other organizations. The CDC states “One Health recognizes that the health of people is connected to the health of animals and the environment. The goal of One Health is to encourage the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment.”
I think that over the years, I’ve had maybe three ‘yes’ answers to these questions, combined. The conclusions are obvious:
  1. The OIE is failing in its mission to educate the other health professions, as well as the general public, on the importance of animal health, both as it relates to animals alone and to human health as well.
  2. The One Health concept is a failed attempt by the veterinary profession to assert its presence into discussions of public health. It represents the profession’s inability to move itself from the general world of agriculture (where it is also clearly important) and place itself among the disciplines of other health sciences.
(As a veterinarian, we are used to being the red headed stepchild of the medical professions, so this doesn’t really surprise or irk me. Sometimes, we even create brilliant concepts, like One Health, so we can pretend that it’s really a thing for those outside of our bubble.)
So, what’s the problem here, specifically regarding rabies?
Let me preface this by saying that , I don’t really trust rabies statistics. The latest updates I’m reading estimate the annual number of rabies deaths at 59,000.  Given that most of these deaths come from rural areas in Africa and Asia with poor access to treatment and prevention, I’m not sure how they come up with that number. (On my to-do list: contact a rabies epidemiologist.) What I do know is that when I first started giving the talk, the number was 25,000 – 50,000. The range itself, varying by 100% of the low number, inspires doubt in and of itself.
That noted, the trend over the past nine years is at best level, and at worst shows an increase of 18%. Rabies does not get a lot of attention. Most diseases of the poor—Chagas’ disease, cysticercosis, leishmaniasis, hydatid disease, and others—get little attention. AIDS/HIV, tuberculosis, and malaria are the exceptions, but two of those are not restricted to poor areas overseas. Rabies kills “only” 59,000 people a year, a number that pales in comparison to the other diseases listed here. But working on one disease does not preclude working on another.  Rabies is low hanging fruit. The numbers of rabies deaths are skewed towards children.  Rabies is not a medical mystery. The bottom line is that no one should die the horrible death that comes with rabies infection.

 

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Parasite Attack! Flesh-eating Worms in the United States!


 

A Meta-Bug News Roundup

Screwworms in Florida

The New World screwworm, Cochliomyia homnivorax, isn’t probably something you think about. Fortunately, you don’t have to. The screwworm, a larval form of a fly, has been eradicated in the United States since 1982.

220px-Cochliomyia_hominivorax_(Coquerel,_1858)220px-Screwworm_larva

Unlike maggots, which eat only dead flesh, the screwworm eats live tissue. When I was in Haiti recently, I saw what they are capable of. Any wound, any abrasion, any cut is an invitation for the flies to show up. Then the larvae come out, and work their way not just into the necrotic parts, but the actual live tissue.

Screwworms obviously present a serious danger to livestock. I can even find you a gross story where they went into a woman’s ear. But since the ’50s, researchers began experimenting with the release of sterile male flies, first on the relatively controlled setting of an island, and then on the mainland. By 1982, there were no more screwworms in the US.

Naturally, flies don’t recognize international borders, so in partnership with Mexico and the nations of Central America, the screwworm has been restricted to south of the isthmus of Panama, a bottleneck that is relatively easy to defend. The breeding of sterile males is ongoing in Panama.

Recently, 40 endangered Key Deer had to be euthanized in Florida when it was discovered that they were infested with screwworms. Sterile males were introduced, the Florida Department of Agriculture set up inspection stations in Key Largo for animals leaving the keys, and the outbreak was contained.

 

Robert Pirsig, author of Zen and the Art of Motorcycle Maintenance, has died.

“When one person suffers from a delusion, it is called insanity. When many people suffer from a delusion it is called a Religion.”

pirsig

Here’s a passage  from Zen  that I always found interesting.

Things are getting worse.

Twittler has proposed huge tax cuts, and naturally they benefit him and those in high income brackets the most. They propose eliminating the inheritance tax, which is probably the best tax we have: WE’RE TAXING DEAD RICH PEOPLE! They’re decomposing, they can’t complain, and if their whiny little offspring think it’s just horrible that they have to be just a tiny bit like the rest of us (which they won’t, they’ll still be stinking rich), well, they can commiserate in their gated communities and in their country clubs, just like they always have. The Great Unwashed will be able to perhaps feed and educate their children a little better. It’s understandable how those at the top don’t really want a level playing field, but keeping the “Paris Hilton” tax–or maybe we should call it the Trump Kids Tax–is a good thing. Just ask Teddy Roosevelt. Whatever you name it, don’t let anyone get away with calling it a “death tax.” It’s not.  It’s a tax on plutocracy and oligarchy.

I can’t write anymore today. A buffoon is fucking up or determined to fuck up so many things at once–relations with Canada and Mexico, military policy, health care, foreign trade– that it’s overwhelming. As I’ve written before, there’s a good chance that the American Experiment has failed, and the wise will at least be keeping an eye open on an exit strategy. While I’m here, I will work to make this a better and safer place, but I do not believe that this is the best place for my children to plan their future in.

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My Street Band Made the New York Times, Marching for Science


Woohoo.

Here we are, the Jamaica Plain Honk Band (subsumed for the day by the Boston Area Brigade of Activist Musicians, otherwise known as BABAM). That figure on the right , sort of behind and to the side of the tuba player?  The guy whose head is out of the picture, but you can see the blue raincoat? Yeah, that’s me. Promise. And that’s E, our young brass player, leading the charge. 25MARCH34-superJumbo

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Shavuah Tov. Impeach Drumpf.


Back to the workaday world.

Just a few links about our ever-crumbling separation of Church and State. And I do mean Church, because it ain’t gonna be synagogues, mosques, or temples.

This from the Washington Post on repealing of the ‘Johnson Amendment, ‘ which would allow tax-exempt houses of worship to become mouthpieces for politicians.

 

And this from New York Magazine on the devout Christian physician

14-willie-parker.w710.h473.2x
Dr. Willie Parker, AP photo.

who travels the South performing abortions for women who need them, which he feels is a moral obligation.

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We Hope for a Better Year in spite of all signs that it’s going to suck royally.


dies-irae

New Year’s Rants

Oh boy. I’m putting myself on a news blackout. The New York Times is my home page, but tonight I think I’m going to have to change it to a comedy. Laughter is good. Best medicine, right? I mean, I could talk about the hell into which we are descending, but if I do that I might as well read the news.

See these results regarding laughter. It’s a good year to learn to use Google Scholar and read a scientific article from peer-reviewed journal, if you don’t already know how to do so.

https://scholar.google.com/scholar?as_ylo=2013&q=laughter+in+groups&hl=en&as_sdt=0,22

ALSO:

Rick Brophy

My cousin Mick is looking for someone he served with in Vietnam. 

rick-brophy

 

 

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TUESDAY TANTRUM: Influenza. Loneliness. Bad business. Vaccinations.


fluI just got a chilling thought.

If I get influenza this winter,

I am fucked. Really fucked. Why? Because I have no friends here. None. If I missed work, someone would call and wonder where I am, but other than that, no one would check up on me. I would have to go to the store and spread my germs, because I wouldn’t have any other way to get food. In addition to the pain of illness would be the added pain of isolation and fear. My 11 year-old daughter would be worried and try to make sure I was OK, but she’s just an 11 year-old who would be in the custody of her mother , Fräulein Schadenfreude, who really hates me and might even take some cruel pleasure in the fact I was alone in my misery. Not that she’s bitter or anything.

I’ve had the flu before. It was debilitating. I was febrile and in pain for a full week. Yeah, sometimes it’s “just the flu”, but at other times it’s the disease that kills around 36,000 Americans per year ( a lot more  Americans than Ebola, West Nile Virus, Eastern Equine Encephalitis  will). Fortunately it’s rare, but other times flut has been the epidemic that has knocked off 3-5% of the world’s population. It’s not the flu—it’s the ‘flu, dumbspeak for influenza.

All in all,I was well cared for. I was at my girlfriend’s mother’s house.  We had driven down to Atlanta for Christmas(see what happens when you date a shiksa!) , and it was my first time meeting the family. I think I made a good first impression.

People with strong connections heal better and are in better general and mental health. Living in isolation is toxic—it can literally shorten your life. What is the worst punishment we can give (short of the death penalty)? Solitary confinement. Lock ‘em up, and let ‘em go nuts.

So winter’s coming up. Whaddaya gonna do?

flu2

First of all, don’t be a moron, and go get your flu shot.

Your immune system is not a muscle. Don’t think that by “stressing” it with exposure to a virus is going to make it stronger.  The flu shot cannot give you the flu, nor will it cause autism, cause narcolepsy, or make you vote for Rick Perry. Unless you are allergic to eggs or religiously opposed( a weak reason, in my humble opinion), there is no reason not to get it. If you are under 50, get the intranasal—it shows better efficacy.

What population needs vaccination the most? School-age children. They run off to the viral exchange facility 5 days out of 7, and they are the super spreaders of the disease. If you want to protect infants and the elderly, it’s better to vaccinate school -age children than vaccinating those groups. I’m not going to argue science with whackos who think that vaccines are poison distributed widely. They can join my raw milk friends and throw a party. Go get your children vaccinated, or you are a parasite worse than Echinococcus multilocularis.

Secondly, don’t go to  work sick.

I worked at a horrible corporate veterinary practice where the manager (where do they find these people? They went through 5 managers in a little over a year. The Company bought into the ridiculous Business School Conceit that if you know how to manage a convenience store you also know how to manage a machine shop or a veterinary practice—the falsity of this claim was demonstrated on a hourly basi, oh how we loved the days when she was off! ) Anyway, as I was saying the manager announced at an office meeting one day that “if anyone is sick and can’t come in to work,  you still have to come in unless you find a replacement.” My response was, “As soon as I hear of anyone coming in with a fever, I’m leaving, and I will recommend that anyone else leave.” I don’t see why the employees should have to do the manager’s job of finding a replacement (other than the manager’s desire to shift the blame off of herself, in addition to  cruelly burdening a sick person with a bad task). And it is sheer lunacy to have sick people come into work. Massachusetts is contemplating a paid sick leave law. Only slavemasters and fools (aka “job creators”) would oppose such a law.

flu3

Thirdly, make sure you’ve got some strong connections.

If you’re sick, you’re going to need friends. If you’re not, they are going to make your life better. Remember: it’s a long winter.

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Veterinary Critical Care, by Sattler, Knowles and Whittick: Buy This Book!


from our filthy lucre department:

Enterotomy--what happens when your dog or cat eats the wrong thing
Enterotomy–what happens when your dog or cat eats the wrong thing

We now interrupt your regular Meta-Bug for this important message.

WRITTEN IN 1981,

This was one of the first books written on veterinary emergency medicine and critical care. Naturally, quite a bit of it is out of date, most notably in the absence of newer pharmaceuticals and the presence of older equipment, some of it already looking rather quaint, like something you might find at a flea market.

However, the general thrust of the book, in terms of what types of cases you might see, how to approach a case, and how to keep records, is still pretty much spot-on.  The chapters are written by different authors (I saw a quote from an article by my old surgery professor, Eb Rosin, zikhrono livrakha, lost to ALS not long after my graduation from my veterinary school).

But as you may have noted from my earlier posts on moving, I have too much stuff, and most of that excess is in books.

I’m moving to Peru for half a year, come December. the nonprofit we started last year, PAZ (Pan American Zoonotic Research and Prevention) needs someone to be on the spot, so I’m going. We have no very little funding at this point. Therefore,  I need to 1) dump stuff, and 2) raise money.

So buy this book!  Even if you’re not a veterinarian, but just someone interested in science and veterinary medicine and animals, you will find this interesting. 100% of your purchase will go to supporting PAZ.

Here is the eBay link.

 

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